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Utilization Management Coordinator

2 months ago

Irvine, California, United States Insight Global Full time

Position Overview:
Insight Global is seeking a dedicated Utilization Management Coordinator to support one of our prominent healthcare partners. This role is essential in ensuring the efficient processing of authorization requests and enhancing departmental operations.

Key Responsibilities:

  • Utilize your knowledge and skills to manage daily activities that may vary in nature.
  • Demonstrate a solid understanding of your role while requiring minimal guidance with referral requests.
  • Independently resolve routine issues while collaborating with supervisors and senior coordinators for more complex challenges.
  • Organize and prioritize your workload to meet deadlines and turnaround times effectively.
  • Collaborate with team members to achieve collective goals and ensure timely completion of tasks.
  • Process assigned work within established productivity and quality benchmarks, maintaining a minimum of 65 authorizations per day and a quality assurance score of 95% or higher on weekly audits.

Additional Duties:

  • Input referral requests into the online system and approve them according to established guidelines.
  • Verify patient eligibility and benefits as part of the authorization process.
  • Investigate administrative issues prior to escalating them to nursing staff.
  • Manage incoming calls for the team, adhering to standard operating procedures.
  • Access necessary information through online systems to support team functions.
  • Serve as the primary contact for outreach, screening, and provider education regarding authorization processing.
  • Communicate effectively with members, families, or caregivers as directed.
  • Contribute to improving departmental communication and processes.
  • Act as a resource for Clinical Services staff and inter-departmental teams.
  • Adhere to record management and documentation protocols while maintaining confidentiality of all member information.
  • Assist with retro review claims processes as needed and support team members in achieving turnaround times.
  • Perform other assigned duties while consistently demonstrating professionalism and embodying the company’s core values of integrity, compassion, relationships, innovation, and performance.
  • Maintain regular attendance and punctuality.

Data Management:

  • Sort and extract data from reports to create necessary health plan documentation.
  • Assist in projects aimed at enhancing efficiency and reducing costs.
  • Prepare documentation for health plan audits and interact with healthcare facilities for medical record requests.
  • Facilitate meetings with healthcare providers as required.
  • Maintain accurate data logs and ensure compliance with HIPAA standards regarding patient information.
  • Perform additional duties as assigned.

We are committed to fostering a diverse and inclusive workplace where all individuals can express their authentic selves. Insight Global is an equal opportunity employer, ensuring that all qualified candidates receive consideration for employment without regard to race, color, ethnicity, religion, sex, sexual orientation, gender identity, marital status, national origin, age, disability, or any other protected status.

Qualifications:

  • High School Diploma or GED required.
  • Minimum of 1 year of experience in Utilization Management.
  • Familiarity with medical terminology is essential.
  • Proficient in Microsoft Office Suite, including Outlook, Word, and Excel.

Preferred Qualifications:

  • 3+ years of experience in a healthcare administrative role.
  • Experience in a medical office setting.
  • Knowledge of compliance or quality improvement processes.
  • Familiarity with CPT coding.

Benefits:
Our benefit packages commence on the 31st day of employment and include medical, dental, and vision insurance, along with HSA, FSA, and DCFSA options, and access to a 401k retirement plan with employer matching. Employees are also entitled to paid sick leave and other paid time off as mandated by applicable laws.