UM Coordiantor

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  • 17-00084
  • Full Time/Contract
  • Utilization Management
  • Rancho Cucamonga, CA
Job Description
CLIENT COMPANY OVERVIEW
Our Client is a not-for-profit, rapidly growing Medi-Cal and Medicare health plan serving over 1,138,447 residents of the Riverside and San Bernardino counties. Our client maintains a Positive Team Culture as demonstrated by being voted by Los Angeles News Group readers as "Favorite Overall Company To Work For , "Favorite Training Program , and "Favorite Workplace Culture in their 2014 Winning Workplaces survey.

JOB TITLE
UM Coordinator- Transportation

DESCRIPTION

  • Reviews and determines need for transportation requests initiated by a Provider or the Member directly.
  • Takes out bound calls to both Members and Providers to obtain necessary information to determine medical necessity of transportation requests.
  • Collaborates with the Medical Directors for transportation requests that do not meet criteria for final decision.
  • Ensures alerts are properly created for Members that meet criteria for continued transportation.
  • Monitors the Transportation authorization queue to ensure transportation requests are processed timely following all regulatory timeframes.
  • Responsible for covering the transportation provider phone queue as directed by management
  • Ensures documentation is accurate and in compliance with regulatory requirements and accredited standards.
  • Participates in the MDI/RIE Huddle to communicate issues that may arise with their processes, using the LEAN principles and the PDSA cycles as they try to solve the issues.
  • Understands the importance of great customer service and timely processing of requests as it pertains to the transformation of IEHP becoming a 5 Star Health Plan.
  • Collaborate and communicate with management on issues and processes that impact UM and other organizational entities internally and externally.
  • Collaborates with the Transportation Vendors to ensure the Members are transported at the correct level.
  • Communicates and collaborates with the Dual Choice Transportation Vendor that manages the Dual Choice Benefit to ensure that IEHP is not transporting Dual Choice Member when they have not exhausted their Benefit.
  • Responsible for Member Outreach when a Transportation authorization has been approved.
  • Any other duties as required to ensure Health Plan operations are successful.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.

REQUIREMENTS AND QUALIFICATIONS

  • Knowledge of utilization management in a health care delivery setting.
  • Experience in an HMO or managed care setting preferred, including Medicare Advantage health plan.
  • Bilingual (English/Spanish) preferred excellent written and verbal communication and interpersonal skills, understanding of and sensitivity to multi-cultural community, strong organizational skills, typing 45 words per minute, proficient in Windows applications, telephone courtesy, high degree of patience, and experience in data entry
  • Two (2) years customer service experience in medical clinics, hospitals, or IPAs. Managed care setting experience preferred.
  • Knowledge of Utilization Management including referral process, ICD-10 and CPT codes preferred.
  • Possession of a high school diploma or equivalent, Associate or Bachelors from an accredited institution preferred.

COMPENSATION | POSITION CLASSIFICATION

  • Commensurate with Experience
  • Full Time | Contract | Non-Exempt

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