Utilization Management UM Coordinator Inpatient

Alignment Health is breaking the mold in conventional health care committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fastgrowing company you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters not only changing lives but saving them. Together.

GENERAL DUTIES / RESPONSIBILITIES:

• Assist team with daily census by entering face sheets for hospitals and skilled nursing facilities (SNF).

• Obtain medical records from hospitals and SNFs.

• Attach medical records to authorizations.

• Enter referral requests / authorizations in system using ICD 10 and CPT coding.

• Monitor fax folders.

• Complete and document tasks as assigned by nurse.

• Maintain documentation on facilities contacted.

• Assist with maintaining and updating members records.

• Assist with mailing or faxing correspondence to facilities related to as needed.

• Request medical records from facilities etc. related to members activities as needed.

• Attend case management presentations and participates as appropriate.

• Recognize workrelated problems and contributes to solutions.

• Meet specific deadlines and respond to various workloads by assigning task priorities according to department policies standards and needs.

• Maintain confidentiality of information between and among health care professionals.

• Be a positive team player.

Job Requirements:

Experience:

Required:

• Inpatient concurrent review experience
• Experience with census and admission management
• Experience in discharge planning
• Experience entering referrals and prior authorizations.
• Experience with Medicare Advantage
• Experience with hospital and / or facilities backend admissions
• Knowledge of medical terminology
• Knowledge of ICD10 and CPT codes
• Knowledge of Medicare HMO MMO managed care plans
• Computer proficient

Preferred:

• Medical assistant experience preferred
• Knowledge working in Access Express / Portal Epic preferred.

Education:

Required:

• High school diploma or general education degree (GED) or 4 years additional experience in lieu of education.

Preferred:

• Medical Terminology Certificate preferred.

Training:

Required:

Preferred:

Specialized Skills:

Required:

• Proficient in Microsoft Office (Outlook Excel Word)
• Able to type minimum 50 wordsperminute (WPM).
• Organized and detail oriented.
• File systematically.
• Good interpersonal skills.
• Strong written verbal and telephonic communication skills
• Able to read write and speak English fluently.

Preferred:

Licensure:

Required: None

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job the employee is regularly required to talk or hear.

2. The employee regularly is required to stand walk sit use hand to finger handle or feel objects tools or controls; and reach with hands and arms.

3. The employee frequently lifts and / or moves up to 10 pounds.

4. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability age protected veteran status gender identity or sexual orientation.

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