SACRAMENTO, CA
We are recruiting for a Utilization Management Coordinator (UMC) to join an established healthcare organization in Sacramento. The UM Coordinator supports activities related to authorization processing for outpatient, inpatient and ambulatory services. This is a contract to hire opportunity! The qualified candidate has three years' experience in the medical field with medical referrals, authorizations, health plans (particularly Medicare and Medi-Cal) and excellent patient customer service. Pay range: up to $22/hour DOE.
PRIMARY RESPONSIBILITIES:
Compile daily inpatient log; review specified UM reports.
Process referrals, generate denial letters and perform retro-review coordination.
Acts as liaison to the providers’ offices and the UM/QM staff.
Provide clerical assistance and prepare reports for the UM/QM Supervisor, Manager and/or Director of Medical Management.
Answer telephone; screen and direct calls to appropriate staff member or department.
Effectively works with providers, nurses, case managers, UM/QM Manager(s), and Medical Directors to ensure system inputs of manual referrals are processed, timely and accurately.
Receive and enters appropriate information from referrals.
Update, maintain, and notify health plans of inpatient census information on daily basis.
Assist with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding member concerns/complaints.
Verify member eligibility by systems inquiry or health plan contact.
Request clinical records per procedure.
SKILLS & QUALIFICATIONS:
High School Diploma or GED is required. AA degree in related field is preferred.
2+ years utilization management coordination experience is required. Minimum of 3 years’ experience in the medical field is required.
Experience with medical insurances, especially Medicare and Medi-Cal is preferred.
Type minimum of 45 WPM.
Ability to multi-task, problem solve and analyze data in a fast-paced environment.
Demonstrated ability to intervene and diffuse difficult calls.
Proficiency with MS Office applications.
Excellent communication skills, both oral and written.
Ability to maintain confidentiality and appropriately share information on a need-to-know basis.