UM Coordinator

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  • 18-00253
  • Full Time/Contract
  • Utilization Management
  • Pasadena, CA
Job Description
CLIENT COMPANY OVERVIEW.
Our client is an innovative network of providers delivering innovative and quality care to patients from Northern to Southern California.

JOB TITLE
UM Services Coordinator

JOB SUMMARY
The UM Services Coordinator process authorizations and ensure that all information is correct before submitting for approval. All authorizations should be entered within a timely manner with complete data as well as the all the documents that will support medical necessity. The UM Coordinator will need to provide strong written/communication skills with Medical Director, Providers, and members to ensure the delivery of high-quality effective healthcare.

JOB DUTIES

  • Open and process UM incoming faxes periodically throughout the business day
  • Answer phones: Providing customer service to calls from providers and /or members
  • Print approvals and modification letters from the database on a daily basis
  • Scan any faxes to existing authorizations in the system
  • Route medical reviewer’s cases to appropriate personnel in timely manner on a daily basis
  • Verify duplicate requests and call/notify doctor’s office of referral request cancellations
  • Contact and follow up with providers on pending clinical/documents within the turnaround time. (Routine 5 days, Urgent 72 hours)
  • Verify and update all missing information (DOS, POS, outpatient or inpatient) before submitting for approval
  • Must have experience in making outgoing phone calls as well as taking incoming phone inquiries **Perform additional UM functions as required by the department

QUALIFICATIONS

  • High School Diploma or equivalent required
  • Minimum 1-year authorizations/referral processing experience in a utilization management setting highly desired
  • High volume (in/outbound) call experience required
  • Considerable knowledge of Medi-Cal/Medicare Managed Care
  • Proficiency in 10-key and MS Office applications
  • Ability to work effectively and accurately in a fast-paced environment
  • Strong work ethic, detail oriented and self-motivated

POSITION CLASSIFICATION & COMPENSATION

  • Full-Time/Contract/Non-Exempt
  • $15.00/hr – $18.00/hr

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