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Coordinator-UtilizationMgt/Rvw. Temporary 9/27/26-3/24/27

Loma Linda University HealthLoma Linda, CA
Onsite

About The Position

The Coordinator-Utilization Management/Review functions effectively in a tertiary care academic medical center with level one trauma designation, ST-Elevation Myocardial Infarction (STEMI) receiving center designation and comprehensive stroke center accreditation in an academic teaching medical center. Works collaboratively with the Clinical Admission Nurse in a fast-paced environment and is responsible for the support of the daily operations of Patient Placement Services related to the admission and transfer of patients into Loma Linda University Health hospitals (Loma Linda University Medical Center (LLUMC), Surgical Hospital, East Campus Hospital, Loma Linda University Children's Hospital) from multiple portals of entry. Coordinates and monitors medical and surgical planned admissions, monitors and updates the Patient Placement and Transfer Center Work Queues. Processes intake calls for ED to ED transfers, interfacility transfers, urgent admissions, including coordinating and connecting transferring physician to receiving physician. Collects pertinent demographic, financial and clinical data on all intake calls. Interfaces with payers and clinics regarding authorization for admission, collaborates with Patient Business Office (PBO) for identification of payer sources/eligibility/indigent programs. Demonstrates ability to make solid decisions and work with minimal supervision. Performs other duties as needed.

Requirements

  • High school diploma or GED required.
  • Minimum of three years of experience with a medical group, managed care organization, utilization management, hospital admitting or medical nursing unit required.
  • Basic knowledge of medical terminology, Health Insurance Portability and Accountability Act (HIPAA) and patient rights required.
  • Working knowledge of healthcare insurances and health plans required.
  • Able to read; write legibly; speak in English (and Spanish preferred) and relate and communicate positively, effectively and professionally with others.
  • Able to think critically; work with minimal supervision and meet firm deadlines.
  • Able to use computer, printer and software programs necessary to the position.
  • Able to operate and troubleshoot equipment required for the position.
  • Able to be assertive and consistent in following policies.
  • Able to work calmly and respond courteously when under pressure.
  • Able to accept and follow directions.
  • Able to perform basic math functions.
  • Able to manage multiple assignments effectively.
  • Able to organize and prioritize workload.
  • Able to collaborate with registered nurse to problem solve.
  • Able to recall information with accuracy.
  • Able to pay close attention to detail.
  • Able to function within scope of practice.
  • Able to distinguish colors, hear sufficiently for general conversation in person and on the telephone.
  • Able to identify and distinguish various sounds associated with the work place.
  • Able to see adequately to read computer screens, medical records and written documents necessary to position.

Nice To Haves

  • Nationally recognized certification in Utilization Management, Utilization Review, Hospital Utilization Review or Managed Care preferred.
  • Spanish language proficiency preferred.

Responsibilities

  • Support the daily operations of Patient Placement Services related to the admission and transfer of patients.
  • Coordinate and monitor medical and surgical planned admissions.
  • Monitor and update the Patient Placement and Transfer Center Work Queues.
  • Process intake calls for ED to ED transfers, interfacility transfers, and urgent admissions.
  • Coordinate and connect transferring physician to receiving physician.
  • Collect pertinent demographic, financial, and clinical data on all intake calls.
  • Interface with payers and clinics regarding authorization for admission.
  • Collaborate with Patient Business Office (PBO) for identification of payer sources/eligibility/indigent programs.
  • Make solid decisions and work with minimal supervision.

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