Coordinator-UtilizationMgt/Rvw. Children's Hospital

Job Description

Job Summary: The Coordinator-Utilization Management and Review is responsible for the support of the daily function and operations of the Case Manager and Discharge Planner related to the utilization management and/or discharge planning: review medical records for or medical necessity of admission, treatment, and initial referrals for Government Programs, interfaces with payers to extend authorization for treatment, collaborates with PBO (Patient Business Office) for identification of payer sources, eligibility, or indigent programs, completes TAR's (Treatment Authorization Requests) for submission to the county field offices for medical authorization, supports medical on-site reviewer functions, assist with reimbursement and authorization according to contracts, coordinates and supports the denials and appeals process. Is able to function under the direction of a Case Manager and Discharge Planner with minimal supervision, takes responsibility for professional growth, and assists in the management of patient placements and ordering of durable medical equipment and coordinating discharge. Performs other duties as needed.

Education and Experience: High School Diploma or GED required. Associate's Degree preferred. Minimum three years of experience with a medical group, managed care organization, utilization management, hospital admitting or medical nursing unit required.

Knowledge and Skills: Acquires and maintains a working knowledge of Medi-Cal, CCS, Healthy Families, commercial regulations, and managed care. Knowledge of state managed health plans and contracting preferred. Knowledge of state managed health plans and contracting preferred. Able to read; write legibly; use computer, printer, and software programs necessary to the position. Able to relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, and collaborate; accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; work independently with minimal supervision; perform basic math functions; manage multiple assignments effectively; work well under pressure; problem solve; organize and prioritize workload; recall information with accuracy; pay close attention to detail. Able to distinguish colors and smells as necessary for patient care; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the work place/patient care; see adequately to read computer screens, medical records, and written documents necessary to position; discern temperature variances through touch.

Licensures and Certifications: Nationally recognized certification in Utilization Management, Utilization review, Hospital Utilization review, Managed Care, or healthcare related required within two years of hire date. Current cardiopulmonary resuscitation (CPR) certificate required.

About Us

Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork and wholeness.

About the Team

Loma Linda University Health is a Seventh-day Adventist, faith and values based Christian institution. Candidates must understand and embrace the mission, purpose, and identity of Loma Linda and its affiliated entities.

We are an equal opportunity employer committed to the principles of diversity. We provide equal opportunities in all aspects of the employment process to every individual, regardless of gender, race, color, age, national origin, ancestry, physical or mental disability, marital or veteran status, genetic information or any other characteristic protected by law. In addition, we will provide reasonable accommodations for otherwise qualified individuals requesting an accommodation due to a disability. If you need accommodation assistance with accessing our job listings or completing an application, or during any other phase of employment with us, please contact Human Resources Management at (909) 651-4001.

Loma Linda University Children's Hospital is a religiously-qualified Equal Opportunity Employer under Title VII of Civil Rights Act of 1964. No question on this application is asked for the purpose of unlawfully limiting or excluding any applicant's consideration for employment because of race, color, religion, gender, age, national origin, disability, genetic information, or any other status protected by applicable law. If you need a reasonable accommodation in the hiring process, please notify Human Resource Management.

We appreciate your interest in Loma Linda and wish you success in your job search

---