Utilization Management Coordinator - Remote

Astrana Health, Inc.•Orange, CA

19h•$22 - $25•Remote

About The Position

The Utilization Management Coordinator is responsible for supporting clinical, management, and client activities, comprising the UM Program. The Utilization Management Coordinator understands all UM processes such as pre-authorizations, retro reviews, Division of Financial Responsibilities and Health Plan contracts. The UM Coordinator will ensure we are processing quality referrals in a timely manner meeting the health plan standards.

Requirements

High School Graduate
Experience with authorizations or referrals in healthcare
Knowledge of medical terminology, RVS, CPT, HPCS, ICD-9 codes
Proficient with Microsoft applications
Good organizational skills, verbal and written communication skills
Ability to multitask and problem solve in a fast pace work environment
Punctuality and detail-oriented
Ability to follow directions and perform work independently according to department standards
Must be a strong team player and have excellent attendance record

Nice To Haves

Bachelor's in Healthcare Administration is a plus
A minimum of two years experienced in managed care environment to include but not limited to an IPA or MSO preferred

Responsibilities

Comply with UM policies and procedures. Annual review of selected UM policies.
Read and understand NMM UM Customer Service Policy and Procedures
Process Routine & Urgent treatment authorization requests according to the NMM Policy & Procedure Manual based on UM Level 1 review process.
Assist with attaching incoming notes to appropriate authorizations
Move referrals coming back from eligibility and or benefits to the correct queue for review
Accurately review, screen and process daily assigned UM referrals (avg 150-250) in accordance with IPA and health plan TAT guidelines
Responsible for verification to include but not limited to: benefit matrix through DOFR, eligibility, provider status (contracted/non-contracted), carved out and others.
Contact providers office as needed for clarification, notes or redirections
Verify that facilities are contracted and or a CMS approved facility when required.
Attend to provider and interdepartmental calls in accordance with exceptional customer service
Reports to UM Lead 3 on activities or problems occurring throughout the day.
Maintains strictest confidentiality at all times.
Maintain good relationships with health plans and medical directors and external contacts.
Team skills, assist others as needed in order to comply with TAT.
Other duties as assigned