Utilization Management Coordinator

3 weeks ago

Sacramento, United States Pacific ExecSearch Full time
Job Description

We are recruiting for a Utilization Management Coordinator (UMC) for 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 ideal candidate has experience with medical referrals, authorizations, health plans and excellent patient customer service. Pay: $18-$21/hour DOE.

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.
QUALIFICATIONS:
  • High School Diploma or GED required. AA degree in related field is preferred.
  • Medical Assistant/Certified preferred.
  • 2+ years utilization management coordination experience is required. Minimum of 3 years' experience in the medical field is required.
  • 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.


Meet Your Recruiter

Karleen Rocheleau

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