Utilization Management Case Manager
3 days ago
We are seeking a detail-oriented and organized professional to join our team as a Utilization Management Intensive Case Management Coordinator. This role will play a vital part in ensuring smooth and efficient case management processes to support quality care at UCLA Health.
Key Responsibilities- Process and manage authorization requests, including urgent, routine, pre-service, and retro authorizations.
- Prepare and process referrals according to established procedures within the medical group utilization department.
- Identify and prepare necessary documents for the next level of review.
- Maintain and prepare specific reports and manage computer applications and logs.
- Monitor members/patients followed by Case Management.
- Work directly with a nurse team lead.
- Review pending claims for approval or denial.
- High school diploma, GED, or equivalent.
- Experience working in a Managed Care environment, highly desired.
- Experience processing ambulatory managed care referrals, preferred.
- Proficient computer skills with working knowledge of Microsoft Excel and Word.
- Ability to operate a variety of office equipment, including computers, printers, copiers, fax machines, scanners, and mailing equipment.
- Ability to multi-task, work with frequent interruptions, and meet deadlines.
- Strong attention to detail, organization, and ability to follow directions.
- Clear and concise communication skills, both written and verbal.
- Familiarity with Vodavi phone system.
- Ability to lift up to 25 pounds.
$34.37-$47.31/hourly
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Los Angeles, California, United States University of California Full time{"title": "Case Management Utilization Coordinator", "subtitle": "Join our team at UCLA Health", "content": "As a Case Management Utilization Coordinator, you will play a vital role in ensuring smooth and efficient case management processes to support quality care at UCLA Health.Under the direction of the Utilization Management, Assistant Manager, you will...
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