LVN; Authorization Coordinator

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  • 17-00167
  • Full Time/Contract
  • Case Management
  • Long Beach, CA
Job Description
CLIENT COMPANY OVERVIEW
Our client is a Managed Care Health Plan that focuses on providing individuals with Medi-Cal, Medicare or Commercial coverage with convenient access to quality, evidence-based medicine, superior value, exceptional service and a network of integrated providers through multiple contracts with various health plans.

LOCATION
Long Beach, CA

POSITION SUMMARY
LVN; Authorization Coordinator
(Managed Care Health Plan)
QUALIFICATIONS & EDUCATION
The Utilization Management Authorization coordinator coordinates and supports activities related to authorization processing for outpatient office visits, durable medical equipment, testing/surgery. The Authorization coordinator is responsible for coordinating authorizations, notifications, denials and pre-certifications.

  • Receives and enters appropriate information in System and ensures that all information is accurate.
  • Process referral authorization from providers in a timely manner, by utilizing established Protocols.
  • Generates approval letters and authorizations
  • Accurately documents all activities as per policy including entry into automated systems.
  • Professionally interacts with customers, acting as a liaison between the patient and provider
  • Provides decision status of authorizations and pre-certs to callers
  • Interprets and applies appropriate, UM Resources and information available on the Intranet, and in system to include but not limited to EOC’s
  • Fax authorizations via fax server and fax machine.
  • Request additional information from Providers, if needed via fax (CT/Notes, etc.)
  • Communicates with the Enrollment Department when incorrect PCP member’s assignments in system have been identified.
  • Gathers and assesses relevant documentation to compare with UM Criteria
  • Communicates with Utilization Physician Reviewer and Case Managers for follow-up and resolution of authorization referrals
  • Verifies member insurance eligibility and benefits
  • Interacts effectively with providers, physician reviewers, and other departments using strong verbal and written communication skills on an on-going basis
  • Applies UM criteria appropriately to authorization requests
  • Apply Timeliness Standards (ICE Timelines Grids)
  • Reports suspected fraud and abuse per company policy
  • Effectively applies policies, procedures and standards, requesting assistance of supervisor or appropriately licensed health professional when necessary
  • Maintains confidentiality of all PHI in compliance with state and feral law and UC Policy. Other duties as assigned.

PREFERRED REQUIREMENTS

  • Current California LVN License
  • One-year managed healthcare; health plan required
  • Acute care and/or SNF experience
  • Prior experience with CCS preferred.
  • Medical terminology proficient
  • Knowledge of ICD9-10
  • Knowledge of CPT codes

COMPENSATION & SCHEDULE
Monday – Friday (days)
$29.00/hr – $30.00/hr

POSITION CLASSIFICATION
Full Time / Contract to Hire


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