Utilization Management Coordinator

3 weeks ago

Orange, United States Astiva Health Full time
Job DescriptionJob Description

Job Title: Utilization Management Coordinator
Target Compensation Range: $26.00-$36.00/hour, depending on the level of relevant qualifications and experience

ABOUT US:
Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY: Under the direction of the Astiva UM Director and Chief Medical Officer, processes Prior Authorization-Referral requests that are received from PCPs and-or Specialty Providers, handles incoming telephone calls and routinely interacts with physicians and their office staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

  • Understands and follows Utilization Management Policies and Procedures pertaining to the referral process.
  • Processes Prior Authorization-Referral requests that are received from PCPs and-or Specialty Providers
  • Responds to all incoming calls and/or follows up calls in a timely manner. Performs the necessary research for determining a satisfactory disposition. Voicemail is checked promptly after breaks and lunches.
  • Works with the Membership Management and Claims and contracting Departments on an as needed basis.
  • Documents all applicable notes, reminders, date/time stamps, initials etc. involved with the referral process.
  • Accepts calls from physicians and/or their office staff, as well as health plan inquiries regarding referral status. When needed, performs the necessary research (i.e., tracks down the referral packet, etc.).
  • Is able to achieve and maintain all applicable departmental production standards and goals.
  • When time permits, all staff are expected to assist others within the department to facilitate workflow and the referral process.
  • Verifies that the patient address in EZ-cap corresponds with prior authorization/referral request form.
  • Recognizes health plan types and makes notation of any/all shared risk or other unique payors or providers as directed.
  • Recognizes all referral types as well as level of urgency and performs accurate data entry within productivity standards.
  • Regular and consistent attendance

EDUCATION and/or EXPERIENCE:

  • Medical Assistant (MA) certification required. LVN Preferred
  • High school diploma or equivalent required.
  • Two years current experience in a medical office or health plan environment.
  • Current knowledge of medical coding and medical terminology.
  • Strong computer skills and proficiency in word processing.
  • Detail oriented, able to function under pressure and perform multi-tasks at any given time.
  • Excellent communication skills, verbal and written

Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

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