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Outpatient Utilization Manager
3 weeks ago
Job Summary: We are seeking a detail-oriented and organized Clinical Coordination Specialist to join our team at MedPOINT Management. In this role, you will be responsible for coordinating clinical activities, communicating with healthcare providers, and maintaining accurate records of patient information.
About the Role:
The Clinical Coordination Specialist will play a critical role in ensuring that patients receive timely and effective medical care. You will work closely with healthcare providers, case managers, and other stakeholders to coordinate care and communicate with patients.
Key Responsibilities:
- Process authorization requests in accordance with state and federal regulations
- Validate data entry for errors and ensure accuracy
- Verify member benefits and eligibility upon receipt of treatment authorization request
- Utilize various tools, including authorization matrices and delegation agreements, to inform decision-making
- Coordinate with referral clinicians and medical directors to facilitate timely processing
- Communicate with medical directors to facilitate medical reviews for non-clinical referrals
- Reach out to members regarding adjudication decisions and providers regarding additional information needed
- Maintain knowledge of CMS and Medi-Cal policy guidelines
- Identify and inform case management clinicians of complex care diagnoses
- Screen cases for possible California Children Services (CCS) eligible conditions
- Read and maintain email inquiries
- Collaborate with other departments to resolve member/provider matters as needed
- Data entry for additional requested services as needed
- Assist with special projects as needed
- Support the Client Support Center with high-volume calls as needed
- Assist team members with workload as needed
- Regular attendance at UM team meetings
Requirements:
- High School graduate or GED equivalent
- One-year medical office experience
- Knowledge of medical terminology
- Proficiency in Microsoft Office programs, especially Word and Excel
- Proficiency in EZCAP a plus
Estimated Salary: $55,000 - $65,000 per year
Benefits:
MedPOINT Management offers a comprehensive benefits package, including medical, dental, and vision insurance, 401(k) matching, and paid time off.
