COORDINATOR-MANAGED CARE

1 month ago


Redlands CA USA, United States Loma Linda University Medical Center Full time
Job Summary: The Coordinator-Managed Care works under the supervision of Manager Managed Care. Provides LLEAP Tapestry training to LLUHC Departments. Tracks Bed Day activity, admits, discharges, and Emergency Room services. Approves referral requests within the scope of position, according to health plan criteria and health plan benefit. Arranges for approved home services. Prepares all utilization management (UM) reports. Communicates with out of network facilities. Prepares data required for UM Audits. Cross covers all key areas of utilization management to ensure compliance with regulations. Performs other duties as needed.

Education and Experience: Minimum five years of managed care experience either with a medical group or a managed care organization, with three years focused in utilization management, health plan criteria and benefit interpretation, authorization determination, and all aspects of health plan UM audits required. Must attain a status of LLEAP Tapestry Credentialed Trainer (CT) status within 90 days of starting position, and maintain.

Knowledge and Skills: Knowledge of medical terminology, medical diagnosis and diagnostic procedures required. Knowledge of healthcare regulatory requirements; thorough understanding of all aspects of the current managed care environment. Able to keyboard 40 wpm. Able to use a computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to work calmly and respond courteously when under pressure; collaborate and accept direction. Able to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.

Licensures and Certifications: None

  • Redlands, United States Loma Linda University Full time

    **Job Summary**:The Coordinator-Managed Care works under the supervision of Manager Managed Care. Provides LLEAP Tapestry training to LLUHC Departments. Tracks Bed Day activity, admits, discharges, and Emergency Room services. Approves referral requests within the scope of position, according to health plan criteria and health plan benefit. Arranges for...


  • Redlands, United States UnitedHealth Group Full time

    Staffing and covering call offs Daily Bulletin Keeping track of Nursing Licensures Preparing the Doctor of the Day Calendar monthly Preparing the weekly LOA for upper management Preparing the new hire tickler files Scheduling AHA Classes and other re Care Coordinator, Patient Care, Coordinator, Patient, Health, Healthcare, Benefits


  • Redlands, United States Visiting Angels of Redlands Full time

    Job DescriptionJob DescriptionBenefits:401(k)Competitive salaryFree uniformsPaid time offTraining & development We are looking for an Office Care Coordinator to help manage our successful Home Care business! This role makes a significant impact on our daily operations and the ability to provide the best care to patients by coordinating medical and health...


  • Redlands, United States Allmed Staffing Inc Full time

    Job DescriptionJob Description8am - 5pm Position background ? What does this position accomplish for the business? Prepare and review authorization requests for medical review to meet regulatory requirements. Please describe the team the candidate will be working with (number of team members break-down of the team?s skill sets team culture etc.). Team of 12...


  • Redlands, United States Allmed Staffing Inc Full time

    Job DescriptionJob Description8am - 5pm Position background ? What does this position accomplish for the business? Prepare and review authorization requests for medical review to meet regulatory requirements. Please describe the team the candidate will be working with (number of team members break-down of the team?s skill sets team culture etc.). Team of 12...


  • Redlands, United States Allmed Staffing Inc Full time

    Job DescriptionJob Description8am - 5pm Position background ? What does this position accomplish for the business? Prepare and review authorization requests for medical review to meet regulatory requirements. Please describe the team the candidate will be working with (number of team members break-down of the team?s skill sets team culture etc.). Team of 12...


  • Redlands, United States Adecco Medical & Science Full time

    Adecco Medical & Science is looking for REMOTE Patient Care Coordinators in Redlands, CA.Please review details below and apply with current resume for consideration. Type: Contract/Temp-to-hire Pay: $18.90 to $ 20.90/hr. Shift: Monday to Friday 8AM to 5PM Responsibilities of the role: Prepare and review authorization requests Check patient benefits ...


  • Redlands, United States Optum Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...


  • Redlands, United States Holiday by Atria - Mission Commons Full time

    Overview: We create communities where employees thrive in their work, helping our residents thrive in their homes. We strive to enhance the lives and exceed the expectations of those we serve every day. To do this, we cultivate the diverse talents of our team members in order to achieve something together that they could not do alone. Atria Senior...

  • Care Manager

    1 month ago


    Redlands, United States Redlands Community Hospital Full time

    Position Details Salary: 60.00 - 60.00 Hourly Shift: Days, 8-hour shifts Status: PRN The purpose of the Care Manager position is to support the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing...


  • Redlands, United States UnitedHealth Group Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...


  • Redlands, CA, United States Fresenius Medical Care Full time

    The registered professional nurse (CAP RN 1) position is an entry level designation into the Clinical Advancement Program for Registered Nurses. The CAP RN 1 is accountable and responsible for the provision and coordination of clinically competent care including assessment planning intervention and evaluation for an assigned group of patients. As a member...


  • Redlands, CA, United States Optum Full time

    OptumCare, the largest employer of Providers in the US, is currently seeking a Family Medicine Physician to join our practice in Redlands, CA. We have developed a reputation for providing quality, compassionate care to communities in the Inland Empire and surrounding area. The Family Medicine Physician is responsible for the day to day clinical care of...

  • Nurse Manager

    2 months ago


    Redlands, CA, United States Redlands Full time

    Reporting to the Nursing Director of Emergency Services & Observation Unit, this position requires the full understanding and active participation in fulfilling the mission of Redlands Community Hospital. The Nurse Manager is responsible for specialty nursing services for the Emergency Department & Observation Unit. The Nurse Manager has 24 hour...


  • Redlands, United States Loma Linda University Full time

    **Job Summary**:The Coordinator-Patient Outreach contacts and schedules appointments for the Managed Care patient population in compliance with the Center for Medicare Services (CMS) regulatory guidelines of office visit requirements for HCC diagnoses capture. Performs clerical and other outreach and patient assistance activities for the various programs and...


  • Redlands, United States Loma Linda University Medical Center Full time

    Job Summary: The Coordinator-Patient Outreach contacts and schedules appointments for the Managed Care patient population in compliance with the Center for Medicare Services (CMS) regulatory guidelines of office visit requirements for HCC diagnoses capture. Performs clerical and other outreach and patient assistance activities for the various programs and...

  • Manager-patient Care

    2 weeks ago


    Redlands, United States Loma Linda University Full time

    **Job Summary**:The Manager-Patient Care, in collaboration with senior administrative team, provides administrative, human resource, and financial management for designated area(s) that provide direct and indirect patient care for an age-specific population with a defined scope of service. Participates in strategic planning process and aligns service goals...

  • Nurse Coordinator

    1 month ago


    Porterville, CA, United States Sierra View Medical Center Full time

    Senior Utilization Management Nurse Coordinator *Shift: 8:00a - 4:30p, exempt position POSITION SUMMARY: ~Under the direction of the Administrative Director of Revenue Cycle, the Senior Utilization Management Nurse Coordinator will monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services and...


  • Redlands, United States Citrus Senior Care Full time

    Overview: We are seeking compassionate and dedicated individuals to join our team as Home Care Aides. As a Home Care Aide, you will provide essential support and assistance to clients in their homes. This is a rewarding opportunity to make a positive impact on the lives of others. **Duties**: - Assist clients with activities of daily living (ADLs) such as...


  • San Jose, CA, United States Kaiser Permanente Full time

    Job Summary: Coordinates with physicians, staff and non-Kaiser providers and facilities regarding patients transitions and discharge planning. In conjunction with physicians, develops plans of care and discharge plans, and makes recommendations for alternative levels of care as required. Essential Responsibilities: Utilization Management: Performs daily...