Healthcare Operations Coordinator

1 day ago


Los Angeles, California, United States E-talentnetwork Full time

About E-talentnetwork

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We are seeking a skilled Healthcare Operations Coordinator to join our team on a 2-month contract with the possibility of extension.

About the Role:

This role involves ensuring that New Century Health Plan members receive high-quality, cost-effective care. You will conduct utilization management activities in line with health plan policies and regulatory guidelines.

You will identify Potential Quality Issues (PQI) and support Provider Dispute Resolution (PDR) processes to ensure compliance and enhance provider satisfaction.

Responsibilities:

  • Conduct thorough clinical assessments to evaluate medical necessity and appropriateness of care
  • Develop and execute effective UM strategies to optimize member outcomes and reduce costs
  • Work with healthcare providers to resolve potential quality issues and improve patient care
  • Analyze data to identify trends and opportunities for process improvement
  • Communicate complex information to various stakeholders, including providers, members, and internal teams

Qualifications:

  • A BSN or MSN degree
  • A current valid California RN license
  • At least two years of experience in utilization management, preferably in Medicare Advantage or managed care
  • Knowledge of Medicare Advantage regulatory guidelines, including CMS regulations
  • Experience with PQI identification and reporting
  • Familiarity with PDR processes
  • Strong clinical assessment and critical thinking skills
  • Proficiency in electronic health records (EHR) and utilization management software
  • Excellent written and verbal communication skills

What We Offer:

E-talentnetwork values diversity and inclusion and encourages applications from a wide range of candidates. All qualified applicants will receive consideration for employment without bias.

The estimated salary range for this position is $80,000 - $110,000 per year, based on experience.

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