Utilization Coordinator - Per Diem

UHS•Temecula, CA

About The Position

The Southwest Healthcare Regional office in Temecula, CA is seeking a Per Diem Utilization Coordinator who will supports the Centralized Utilization Review department and collaborates with staff across the Southern California Region. Duties include but not limited to: Outreach to payers via phone or fax for authorization/denial outcomes. Accesses payer portals daily to retrieve authorizations/denials and records outcomes. Reconciles all payer correspondences and runs daily department reports, taking action if needed. Run daily department reports and take action if needed. Enter all denials received into Artiva, manage worklist, and facilitate peer to peer. Mains Medi-Cal TAR logs and audits, accesses Medi-Cal portal to submit required documents. Retrieves and delivers messages from Utilization Review Dept phone review line at least 4 times per day. Answers telephone professionally and courteously. Performs other related duties as requested by the UM Manager.

Requirements

High School Graduate or equivalent required.
Two (2) years of administrative experience in a healthcare setting required. Utilization management, managed care, or related role preferred.
Demonstrates knowledge and ensures compliance with the Nurse Practice Act, The Joint Commission and Title 22 standards and guidelines.
Demonstrates compliance with healthcare policies and procedures at all times.
Demonstrates strong leadership, organization, communication and interpersonal skills.
Demonstrates ability to relate to clinical personnel and medical staff, as well as ability to interact well with the public.
Must have knowledge of PC and applications.
Ability to demonstrate effective written and verbal communication skills.
Computer skills desirable.
Ability to respond to any communication required by telephone.

Nice To Haves

Utilization management, managed care, or related role preferred.
Computer skills desirable.

Responsibilities

Outreach to payers via phone or fax for authorization/denial outcomes.
Accesses payer portals daily to retrieve authorizations/denials and records outcomes.
Reconciles all payer correspondences and runs daily department reports, taking action if needed.
Run daily department reports and take action if needed.
Enter all denials received into Artiva, manage worklist, and facilitate peer to peer.
Maintains Medi-Cal TAR logs and audits, accesses Medi-Cal portal to submit required documents.
Retrieves and delivers messages from Utilization Review Dept phone review line at least 4 times per day.
Answers telephone professionally and courteously.
Performs other related duties as requested by the UM Manager.