Medical Management Coordinator

2 weeks ago


Camarillo, California, United States Clinicas del Camino Real Full time

Job Title: Medical Management Coordinator

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Estimated Salary: $93,000 - $123,000 per year

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The UM Nurse plays a crucial role in managing the medical management process, ensuring that service requests are medically necessary and appropriate. The ideal candidate will have excellent communication skills, with the ability to build strong relationships with internal and external stakeholders.

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Key Responsibilities:

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  1. ">
  2. Conduct thorough clinical reviews for service requests, utilizing detailed knowledge of medical policies, clinical guidelines, and benefit plans.">
  3. Develop and maintain effective relationships with internal and external clinical teams to resolve barriers to referrals and care.">
  4. Ensure that assigned health plans are meeting or exceeding Medicare/Medicaid/Commercial performance benchmarks per health plan contracts.">
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Requirements:

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  • Graduate of an accredited nursing program required (e.g. ASN, ADN, BSN, MSN) Bachelor's degree preferred.">
  • Active, valid, & unrestricted Active, State of California Registered Nurse license required.">
  • Understanding of federal and state regulations/requirements, including HIPAA, and/or JCAHO or NCQA criteria.">
  • Strong analytical and critical thinking skills and ability to identify complex care coordination opportunities.">
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About Us: At Clinicas del Camino Real, we strive to provide exceptional patient care and services. Our team is dedicated to delivering high-quality care, and we invite talented professionals to join us in this mission.

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