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Utilization Management Coordinator I

Camarillo, CA

Temp-Hire

$DOE

General Summary

  • The role of the Utilization Management Coordinator is to promptly,efficiently and accurately execute all aspects of the referral process. Promote the quality and cost effectiveness of medical care through strict adherence to all UM Policy and procedure.

Essential Functions

  • Communicate effectively and interact with the utilization review nurse and health plans daily or as indicated regarding UM and referral authorization issues.

  • Data entry via EZ CAP software

  • Process request that are approved, denied or deferred and in accordance with utilization management policy and procedure.

  • Responsible for Deferred authorization maintenance, tracking and follow up.

  • Responsible for the EIOD process, including log maintenance; and member notifications

  • Returns phone calls to members, physicians and health plans and follows up with requests.

  • Maintain turnaround time compliance in all aspects of the UM process.

  • Maintain all reference material that is provided by the supervisor, manager or director.

  • Know and follow the Employee Handbook policies and procedures.

  • Maintain patient confidentiality so that HIPAA compliance is observed at all times.

  • Demonstrates honesty and integrity in everyday activities.

  • Recognizes when an error has been made and immediately reports to appropriate manager.

  • Maintain regulatory Turn Around Time Standards per CMS (Seniors)and ICE (Commercial).

  • Maintains quality monitors as assigned by Manager.

  • Assists other staff and supports the team approach.

  • Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.

  • Communicates appropriately and clearly to management, co-workers,and physicians.

  • Other Duties as assigned

Qualifications

  • Knowledge of Healthcare and Managed Care preferred.

  • Typing 40 words per minutes with accuracy.

  • Knowledge of computers, faxes, printers and all other equipment.

  • Proficient in MS Office programs (i.e., Word, Excel, Outlook,Access and Power Point).

  • Ability to multi-task and meet deadlines.

Performance Requirements

Knowledge:

  • Knowledge of healthcare protocols/procedures, including healthcare coding.

  • Knowledge of coordination of benefits.

  • Knowledge of Medicare processing guidelines

  • Knowledge of the EZ-Cap and Crystal operating system.

Skills:

  • Possess tact and diplomacy in interpersonal interactions.

  • Manage staff on a daily basis.

Abilities:

  • Ability to project a pleasant and professional image.

  • Ability to plan, prioritize and complete delegated tasks.

  • Ability to demonstrate compassion and caring in dealing with others.

  • Equipment Operated: Computers, copier/scanners, fax machines,phones.

  • Work Environment: Well-lit, well-ventilated, adequate office space.

  • Mental/Physical Requirements: Ability to lift 30lbs, work at a computer with intermittent breaks.

Please apply at:

OnDemand Employment Group

2011 Auto Center Drive #116

Oxnard 93036

P:805 485-4606

F:805-485-4607

E: ODEGJOBS@gmail.com

Please bring with you 2(two) forms of valid identification and an updated resume.

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