UM Compliance Coordinator

Advanced Medical Management•Long Beach, CA

1d•$22 - $25

About The Position

The UM Compliance Coordinator supports utilization management reporting, audits, and related program activities. The role assists the Compliance Manager, Quality Manager, and Director of Care Management with eliminating corrective action plans (CAPs) and implementing process improvements to achieve better outcomes. The coordinator communicates barriers that may prevent timely and efficient completion of tasks to the VP of Operations, maintains patient confidentiality, and supports departmental and organizational goals. The position reports to the Compliance Manager.

Requirements

One year of experience in a physician's office or clinic, or as a coordinator in an IPA/group UM or CM department, is preferred; applicants with a bachelor's degree from a recognized university will also be considered and trained.
Medical terminology training and medical or other healthcare-related experience are preferred.
Ability to communicate orally and in writing.
Ability to use common sense, comprehend simple instructions, and carry out detailed written and/or oral instructions.
Ability to efficiently prioritize multiple high-priority tasks.
Ability to work independently, stay organized, and work with minimal supervision.
Ability to maintain strict confidentiality of patient information and IPA business.

Nice To Haves

One year of experience in a physician's office or clinic, or as a coordinator in an IPA/group UM or CM department.
Medical terminology training.
Medical or other healthcare-related experience.

Responsibilities

Schedule and prepare for CM/UM/QM audits.
Manage the audit calendar and Excel schedule.
Run and manage reports listed in the Policies and Procedures (P&P).
Assist the Compliance Manager, Quality Manager, and Director of Care Management with eliminating CAPs and operationalizing process improvement techniques.
Assist with automating reports as needed.
Maintain the confidentiality of member and medical or clinical information.
Adapt to departmental changes, workload, and emergencies as necessary.
Understand and follow Policies and Procedures.
Ensure letter-program templates are accurate for the health plan, including new and updated information from the ICE website.
Ensure the privacy and security of protected health information (PHI) in accordance with AMM policies and procedures relating to HIPAA compliance.
Perform other duties as directed by the Compliance Manager.
Provide backup support for managing the Audit Manager application for UM issues.
Provide backup support for creating denial letters that meet the eighth-grade language requirement.