UM Coordinator

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  • 19-00236
  • Direct Placement
  • Utilization Management
  • Monterey Park, CA
Job Description
Position
UM Coordinator
(IPA/Medical Group)
 
Description
Provides access to appropriate services within the time frame specified by NCQA and NIPAC standards.  Guidelines used to determine medical necessity for all authorizations are based on established community standards

  • Will communicate work productivity and any issues with regards to daily function to the UM/QM Manager.
  • Process and edit Routine, Retro & Urgent CHN treatment authorization requests according to the NMM Policy & Procedure Manual.
  • Responsible for obtaining authorization approvals from the appropriate physician assigned to that IPA.
  • Answer all incoming calls with respect to general information regarding an authorization.
  • Responsible for ensuring that all approval and modification letters are sent out. Modification letters are faxed occasionally, per the request of providers/specialists.
  • Verify Benefits and Eligibility for all authorization of services.
  • Call health plan for pre-certification of surgeries, DME, home health, outpatient services.
  • Placing orders and authorization regarding DME, home health, etc.
  • Reports daily to UM/QM Manager on activities occurring throughout the day.
  • Review charts with MD.
  • Performs other duties as assigned.
  • Maintains strictest confidentiality at all times.
  • Other duties may be assigned.

Requirements

  • Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.

Compensation
$16.00/hr – $17.50/hr
 
Additional Information
Full-Time; Benefited

 


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