Utilization Management Case Manager
1 week ago
Take on a vital role within a leading health organization, UCLA Health, and contribute to ensuring smooth and efficient case management processes to support quality care.
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.
- 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.
We welcome all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person's unique achievements and experiences to further set us apart.
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