Case Management Coordinator

2 days ago


Beverly Hills, California, United States Cedars-Sinai Full time
Job Title: Case Management Coordinator

Cedars-Sinai is seeking a highly skilled Case Management Coordinator to join our team. As a Case Management Coordinator, you will play a critical role in supporting the utilization review process and working collaboratively with various teams to ensure the delivery of high-quality, cost-effective healthcare.

Key Responsibilities:
  • Enter data and process referral authorization requests, ensuring accurate coding and quantities.
  • Provide exceptional customer service by answering incoming calls from providers, IPAs, and medical groups, and assisting with queues as needed.
  • Manage the Fax Inbox, distributing incoming faxes and ensuring compliance with internal security measures.
  • Verify member eligibility before processing authorizations.
  • Collaborate with UM Nurses, Medical Directors, and Management to research issues and resolve discrepancies.
  • Identify non-contracted providers and request Letters of Agreement when necessary.
  • Request support documentation from IPAs and medical groups as required.
  • Process extensions and denial letters, and prepare utilization review reports as needed.
  • Assist Case/Care Managers in coordinating and arranging services for members.
  • Provide support to the Claims Department as requested.
  • Document patient-specific information in relevant information systems.
  • Assist in verifying health plan benefits and coordinating ambulatory services.
  • Review hospital admissions information and update inpatient, SNF, home health, and DME referrals as needed.
  • Print and distribute daily census.
  • Seek referrals for target patient populations, including fragile seniors, catastrophic cases, and patients with specific diseases.
  • Act as a liaison, capturing information and documenting patients referred to ACM/disease state management programs.
  • Assist in coordinating care for high-risk/high-cost patient populations, including referrals to community resources and ancillary providers.
Qualifications:
  • High school diploma/GED required.
  • One year of healthcare experience, with a general knowledge of medical terminology and experience with community resources and social supports.
  • One year of utilization management or managed care experience preferred.

Cedars-Sinai is a leader in providing high-quality healthcare, encompassing primary care, specialized medicine, and research. We are committed to transforming healthcare for the benefit of patients and improving the health of our community.


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