Utilization Management Coordinator

4 weeks ago

Montebello, United States Cross Country Workforce Solutions Group Full time
Job DescriptionJob Description

Position Summary

This position has primary responsibility for gathering relevant information for the identified member population during assessment, care planning, interdisciplinary care team meeting, and transitions of care. This position performs troubleshooting when problems situations arise and takes independent action to resolve complex issues. 

 

Responsibilities

1. Input data into the case management system to ensure timely care coordination and outreach. 

2. Verifies member benefits and eligibility upon receipt of care coordination and/or case management. 

3. Utilizes DOFR and/or delegation agreements to drive decision-making. 

4. Coordinates and assists with patient appointments, transportation, and/or community resources. 

5. Has primary responsibility for gathering relevant information for the identified member population during assessment, care planning, interdisciplinary care team meeting, and transitions of care. 

6. Completes applicable patient assessments. 

7. Completes problem solving and coordination for patients in collaboration with case manager. 

8. Outreach to patients to verify that needs are being met and services are being delivered. 

9. Intervenes at the client level to coordinate the delivery of direct services to clients and their families. 

10. Coordinates with Primary Care and Specialist providers. 

11. Facilitates documentation and communication with CCS authorizations, third-party payers and clinical staff to ensure authorization of services. 

12. Responsible for ensuring all community resources are explored and/or exhausted prior to purchase of service utilization. 

13. Serves as an associate and resource to patients, providers, staff, and external customers regarding policies, benefits, and care coordination. 

14. Demonstrates excellent communications skills and interpersonal relationships. 

15. Collaborates and facilitates interdisciplinary team communications. 

16. Perform additional duties as assigned. 

17. Process model of care required elements within the dept. targets. 

18. Meets minimum caseload requirements. 

19. Achieves minimum audit score for core responsibilities.



Requirements

1. High School Diploma or equivalent required. 

2. Prior experience working in a clinic/health care call center. 

3. Minimum 2 years of experience working in a health care environment; knowledge of prior authorization and case management regulations governing Medi-Cal, Commercial, Medicare, CCS, and other government and commercial programs. 

4. Prefer experience in a managed health care environment, preferably IPA, HMO, or Health Plan. 

5. Prefer experience working with an ethnically diverse population. 

Company DescriptionCross Country Workforce Solutions Group (CCWSG) is a human resource, consulting and talent acquisition firm, specializing in PACE Programs, FQHCs/CHCs, and State Healthcare plans throughout the US. Our national operations center is located in Southern California.
CCWSG provides clinical and non-clinical staffing support to PACE centers across the country; we are the nation’s exclusive provider of non-medical, in-home caregivers for the elderly enrolled in PACE programs. Currently, we have over 3,000 caregivers supporting patients in their homes through PACE.
We are a part of the Cross Country Healthcare family, a market-leading workforce solutions, tech-enabled talent platform, and staffing, recruitment, and advisory firm with almost 40 years of industry experience and insight. We are a full-service partner, combining market expertise and services, including contingent staffing, consulting, human capital, management solutions, recruitment process outsourcing, vendor management, and direct hiring.Company DescriptionCross Country Workforce Solutions Group (CCWSG) is a human resource, consulting and talent acquisition firm, specializing in PACE Programs, FQHCs/CHCs, and State Healthcare plans throughout the US. Our national operations center is located in Southern California.\r
CCWSG provides clinical and non-clinical staffing support to PACE centers across the country; we are the nation’s exclusive provider of non-medical, in-home caregivers for the elderly enrolled in PACE programs. Currently, we have over 3,000 caregivers supporting patients in their homes through PACE.\r
We are a part of the Cross Country Healthcare family, a market-leading workforce solutions, tech-enabled talent platform, and staffing, recruitment, and advisory firm with almost 40 years of industry experience and insight. We are a full-service partner, combining market expertise and services, including contingent staffing, consulting, human capital, management solutions, recruitment process outsourcing, vendor management, and direct hiring.

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