Utilization Management Coordinator II

AltaMed•Montebello, CA

11d

About The Position

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day. Job Overview This Coordinator II of Utilization Management is responsible for providing support to the Medical Management department to ensure the timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines. This position performs troubleshooting when problem situations arise and takes independent action to resolve complex issues.

Requirements

High School Diploma or equivalent required.
Minimum 2 years of experience working in a medical billing environment (IPA or HMO preferred), with pre-authorizations and reimbursement regulations about Medi-Cal, CCS, and other government programs required.
Prior experience in utilization management, processing authorization referrals is also required.

Nice To Haves

MA or Medical Billing Certificate preferred.
Prefer prior Lead position experience.

Responsibilities

Providing support to the Medical Management department to ensure the timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines.
Performing troubleshooting when problem situations arise.
Taking independent action to resolve complex issues.