Utilization Management Coordinator, Full-TimeRemote

Whittier, CA - USA

Monthly Salary: USD 21 - 32

Posted on: 2 days ago

Vacancies: 1 Vacancy

Job Summary

The Utilization Management (UM) Coordinator provides MSO referral management services. The UM Coordinator serves as a liaison between members physicians providers and MSO staff processing initial intake of information assisting with authorization functions and gathering information. Position is responsible for reviewing and processing requests for authorization and notification of medical services from health professionals clinical facilities and ancillary providers. The incumbent is responsible for tasks/functions related to the MSOs prior authorization and referral process including applying the MSOs criteria and policies/procedures to authorization requests from medical professionals clinical facilities and ancillary providers. The UM Coordinator will directly interact with providers acting as a resource for their needs.

PIH Health is a nonprofit regional healthcare network that serves approximately 3 million residents in the Los Angeles County Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital PIH Health Good Samaritan Hospital PIH Health Whittier Hospital 37 outpatient medical office buildings a multispecialty medical (physician) group home healthcare services and hospice care as well as heart cancer digestive health orthopedics womens health urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nations top hospital systems for best practices cutting-edge advancements quality of care and healthcare technology. For more information visit or follow us on Facebook Twitter or Instagram.

Required Skills

Excellent verbal and written communication skills
Familiar with EzCap
Minimum typing speed of 40 wpm.
Able to prioritize and delegate effectively.
Attention to details.
Excellent organizational skills.
Must be familiar with Health Plan benefit verification
Must have knowledge of medical terminology
Proficient in Windows Microsoft Word and Excel.
Develop and maintain effective working relationships with all levels of staff community agencies providers and members.
Maintain an understanding of current CPT ICD-10 and HCPCS codes and continual updates to knowledge base regarding the codes.
Utilize prior authorization protocols to determine when to refer matters to a licensed staff person.

Required Experience:

Required Skills

Excellent verbal and written communication skills
Familiar with EzCap
Minimum typing speed of 40 wpm.
Able to prioritize and delegate effectively.
Attention to details.
Excellent organizational skills.
Must be familiar with Health Plan benefit verification
Must have knowledge of medical terminology
Proficient in Windows Microsoft Word and Excel.
Develop and maintain effective working relationships with all levels of staff community agencies providers and members.
Maintain an understanding of current CPT ICD-10 and HCPCS codes and continual updates to knowledge base regarding the codes.
Utilize prior authorization protocols to determine when to refer matters to a licensed staff person.