UM Training Coordinator

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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Develop, coordinate, and provide employee orientation/education programs that encompass onboarding new employees as well as continuing education for all Utilization Management (UM) non-clinical staff. Develop and maintain policies and procedures, desktop references, and resource materials. "Train the trainer" by facilitating training and being a mentor for UM subject matter expert roles within Health Services (HS). Demonstrate effective leadership by developing teamwork, managing change, and encouraging innovation and staff involvement in utilization management. Support and develop initiatives that reflect the department vision and are committed to achieving the goals and objectives of Health Services.

Essential Responsibilities:

• Develop, maintain, and present training programs in coordination with Health Services leadership and other training coordinators which ensure the UM team is trained to provide exceptional customer service, meet ongoing operational and regulatory needs, and achieve quality outcomes.
• Develop, organize, and maintain a centralized electronic system of standardized reference tools and training materials that reflect current practice and compliance standards both internally as well as within the broader health insurance industry.
• Ensure regulatory compliance with all state and federal guidelines as well as other accrediting entities.
• Assist with audit processes at least quarterly. Ensure UM materials are in a state of audit readiness. Participate in onsite audits as requested.
• Ensure that each new hire is provided with the tools to successfully begin their new position. Meet with the new employee regularly within their first 90 days of employment and at supervisor discretion thereafter to determine additional educational needs.
• Responsible for training and providing updates of new and revised team resource and training material to Health Services staff.
• Utilize LEAN methodologies and quality improvement principles to practice and promote continuous improvement; utilize visual boards and daily huddles to monitor and communicate key performance indicators (KPI) and identify opportunities for improvement and evaluation of actions taken.
• Participate in Health Service department and team meetings and other meetings as assigned.
• Assist employers, agents, and provider partners as indicated with questions regarding healthcare resources and procedures for employees, members and clients as indicated.
• Serve as a liaison to PacificSource departments to coordinate optimal provision of utilization management services and information. Assist with answering external and internal inquiries, providing exceptional service.

Supporting Responsibilities:

• Act as backup for other Health Services department staff as needed and within scope of licensure.
• Serve on designated committees, teams, and task groups, as directed.
• Represent the Heath Services department, both internally and externally, as requested by Medical Director and Health Services leadership.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

Work Experience: A minimum of four years of health insurance industry or medical background required. A minimum of two years working in the PacificSource Health Services Department preferred. Demonstrate an overall understanding of utilization management and claims costs.

Education, Certificates, Licenses: High school degree or equivalent required.

Knowledge: Microsoft Office software including Word and Excel. CPT/ICD-9 coding, call tracking software, mainframe and medical management software. Thorough knowledge of utilization management, including referral and preauthorization, to support continuity of care. Knowledge of health plan eligibility, benefits, medical interventions and management. Strong knowledge of medical terminology. Ability to work under time pressure. Ability to prioritize responsibilities and to diplomatically handle demanding situations. Ability to work independently with minimal supervision. Must be able to function as part of a collaborative, cohesive community.

Competencies:

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 25% of the time.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.