Utilization Management Coordinator

We are recruiting for a Utilization Management Coordinator (UMC) to join an established healthcare organization in Sacramento. The UM Coordinator supports activities related to authorization processing for outpatient inpatient and ambulatory services. This is a contract to hire opportunity! The qualified candidate has three years experience in the medical field with medical referrals authorizations health plans (particularly Medicare and Medi-Cal) and excellent patient customer service. Pay range: up to $22/hour DOE.

PRIMARY RESPONSIBILITIES:

• Compile daily inpatient log; review specified UM reports.

• Process referrals generate denial letters and perform retro-review coordination.

• Acts as liaison to the providers offices and the UM/QM staff.

• Provide clerical assistance and prepare reports for the UM/QM Supervisor Manager and/or Director of Medical Management.

• Answer telephone; screen and direct calls to appropriate staff member or department.

• Effectively works with providers nurses case managers UM/QM Manager(s) and Medical Directors to ensure system inputs of manual referrals are processed timely and accurately.

• Receive and enters appropriate information from referrals.

• Update maintain and notify health plans of inpatient census information on daily basis.

• Assist with examination of records related documents corresponds with providers and health plan personnel to obtain facts regarding member concerns/complaints.

• Verify member eligibility by systems inquiry or health plan contact.

• Request clinical records per procedure.

SKILLS & QUALIFICATIONS:

• High School Diploma or GED is required. AA degree in related field is preferred.

• 2 years utilization management coordination experience is required. Minimum of 3 years experience in the medical field is required.

• Experience with medical insurances especially Medicare and Medi-Cal is preferred.

• Type minimum of 45 WPM.

• Ability to multi-task problem solve and analyze data in a fast-paced environment.

• Demonstrated ability to intervene and diffuse difficult calls.

• Proficiency with MS Office applications.

• Excellent communication skills both oral and written.

• Ability to maintain confidentiality and appropriately share information on a need-to-know basis.