Coordinator - Utilization Management Outpatient

4 weeks ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time

Overview:
**What you can expect**

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an **authentic experience**

Under the general direction of the UM Outpatient Manager and Supervisor, the Outpatient UM Coordinator, is a high paced position that requires timely processing of authorization requests, verifying eligibility and obtaining additional information as requested by Medical Management or Utilization Management Nurses. This position requires that one be organized, ability to multitask with a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The Outpatient UM Coordinator will also ensure that provider calls are responded to in an accurate and timely manner while always maintaining highest level of customer service, in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.

**Major Functions (Duties and Responsibilities)**

1. Responsible for monitoring the Right Fax Server. Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
2. Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoded referrals.
3. Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.
4. Responsible for representing the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
5. Communicate with providers in consultation with the Utilization Management Nurse, regarding authorizations, modifications, denials, and other matters pertinent to processing authorization requests or other UM related correspondence.
6. Assist Management or Utilization Management Nurses as requested.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits:
**Perks**

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
- Competitive salary.
- CalPERS retirement.
- State of the art fitness center on-site.
- Medical Insurance with Dental and Vision.
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development.
- Wellness programs that promote a healthy work-life balance.
- Flexible Spending Account - Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance

Qualifications:
**Education & Experience**
- Minimum of three (3) years of experience as a data entry specialist or coordinator.
- High school diploma or GED required.

**Key Qualifications**
- Requires knowledge of ICD-9/10 and CPT codes.
- Managed Care or physician office a must.
- Good customer service skills.

Pay Range: USD $23.98 - USD $30.57 /Hr.

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