Utilization Management Coordinator

Pacific Temporary Services•Sacramento, CA

1d•$22

About The Position

We are recruiting for a Utilization Management Coordinator (UMC) to join an established healthcare organization in Sacramento. The UM Coordinator supports activities related to authorization processing for outpatient, inpatient and ambulatory services. This is a contract to hire opportunity! The qualified candidate has three years' experience in the medical field with medical referrals, authorizations, health plans (particularly Medicare and Medi-Cal) and excellent patient customer service. Pay range: up to $22/hour DOE. PRIMARY RESPONSIBILITIES: Compile daily inpatient log; review specified UM reports. Process referrals, generate denial letters and perform retro-review coordination. Acts as liaison to the providers’ offices and the UM/QM staff. Provide clerical assistance and prepare reports for the UM/QM Supervisor, Manager and/or Director of Medical Management. Answer telephone; screen and direct calls to appropriate staff member or department. Effectively works with providers, nurses, case managers, UM/QM Manager(s), and Medical Directors to ensure system inputs of manual referrals are processed, timely and accurately. Receive and enters appropriate information from referrals. Update, maintain, and notify health plans of inpatient census information on daily basis. Assist with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding member concerns/complaints. Verify member eligibility by systems inquiry or health plan contact. Request clinical records per procedure.

Requirements

High School Diploma or GED is required
2+ years utilization management coordination experience is required
Minimum of 3 years’ experience in the medical field is required
Type minimum of 45 WPM
Ability to multi-task, problem solve and analyze data in a fast-paced environment
Demonstrated ability to intervene and diffuse difficult calls
Proficiency with MS Office applications
Excellent communication skills, both oral and written
Ability to maintain confidentiality and appropriately share information on a need-to-know basis

Nice To Haves

AA degree in related field is preferred
Experience with medical insurances, especially Medicare and Medi-Cal is preferred

Responsibilities

Compile daily inpatient log
Review specified UM reports
Process referrals
Generate denial letters
Perform retro-review coordination
Acts as liaison to the providers’ offices and the UM/QM staff
Provide clerical assistance and prepare reports for the UM/QM Supervisor, Manager and/or Director of Medical Management
Answer telephone; screen and direct calls to appropriate staff member or department
Effectively works with providers, nurses, case managers, UM/QM Manager(s), and Medical Directors to ensure system inputs of manual referrals are processed, timely and accurately
Receive and enters appropriate information from referrals
Update, maintain, and notify health plans of inpatient census information on daily basis
Assist with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding member concerns/complaints
Verify member eligibility by systems inquiry or health plan contact
Request clinical records per procedure