- Full Time/Contract
- Utilization Management
- Rancho Cucamonga, CA
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.
UM Coordinator Inpatient
Under the general direction of the Inpatient Nurse Supervisor and Manager and collaboration with the Inpatient Clinical Team, the Inpatient Coordinator, is a high paced position that requires timely processing of incoming inpatient admission and discharge information as well as timely processing of inpatient service requests as requested by Utilization Management Nurses. This position requires that one be organized with the ability to multi task with a working knowledge of ICD.10, CPT Coding and Medical Terminology. The Inpatient Coordinator will demonstrate the ability to work as an extension of the clinical team to complete all non-clinical functions as indicated.
1. Responsible for monitoring the Right Fax server, EDI Interface, and medical management system intake to all face sheets are processed in a timely manner.
2. Responsible for ensuring that hard copy and electronic facesheets are complete and accurate to reflect current Member demographic information.
3. Responsible for daily review of the daily census report in an effort to eliminate duplicates or other admission received from all contracted and non-contracted facilities not required by the health plan.
4. Responsible for the approval of service requested within the Inpatient Coordinator scope as indicated by the Utilization Management Guide approved by the Utilization Management Subcommittee.
5. Responsible for obtaining member discharge dates through daily calls or memo submissions to contracted and non-contracted facilities.
6. Responsible for meeting the performance measurement standards for productivity and accuracy as well as timely processing of inpatient authorizations, inpatient service requests, and discharges.
7. Responsible for ensuring that Members receive Home Health or Durable Medical Equipment (DME) items as ordered via phone call and documentation of call within the medical management system.
8. Responsible for representing the Company in a friendly and professional manner while answering the calls for the Utilization Management Department.
9. Communicate with providers/facilities in consultation with the Utilization Management Nurse, regarding authorizations, orders, and clinical reviews.
10. Assist and provide support to Management or Inpatient Clinical Team as requested.
11. Any other duties as required ensuring plan operations are successful.
12. Ensure the privacy and security of PHI (Protected Health Information) as outlined in Company’s policies and procedures relating to HIPAA compliance.
QUALIFICATIONS / REQUIREMENTS
|Education/License:||High School diploma or equivalent required. Associates degree preferred.|
|Experience:||Minimum of three years of experience as a data entry specialist or coordinator, preferably in an HMO or Managed Care setting. Knowledge of computer applications, including word processing, database spreadsheets. Requires knowledge of ICD-10 and CPT codes. Utilization Management experience preferred|
|Knowledge/Skills Required:||Knowledge of computer applications, including word processing, database and spreadsheets. Requires knowledge of ICD-9/10 and CPT codes. Managed Care or physician office a must. Good customer service skills.|
Full Time; Contract