UMC I
3.
0 Sacramento, CA Sacramento, CA Full-time Full-time $18 - $22 an hour $18 - $22 an hour 2 days ago 2 days ago 2 days ago Job
Summary:
UM Coordinator l coordinates and supports activities related to authorization processing for outpatient, inpatient and ambulatory services.
Compiles daily inpatient log; reviews specified UM reports; processes referrals, completes denial letters and performs retro-review coordination.
QM coordination of grievances/activities/QOC, and CCS related activities.
Acts as liaison to the providers' offices and the UM/QM staff.
Provides clerical assistance and prepares reports for the UM/QM Supervisor, Manager and/or Director of Medical Management Essential Job Functions:
Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position.
Answers telephone in a prompt, professional, courteous and helpful manner; screens and directs calls to appropriate staff member or department.
Responds to routine requests and completes customer service tickets daily while maintaining an accurate phone call log.
Receives and processes inpatient notifications within established policies & procedures guidelines, and turnaround time.
Updates and submits appropriate logs and reports to health plans (i.
e.
, face sheets, denials, daily inpatient census reports and additional information as instructed).
Generates denial eligibility letters Effectively works with providers, nurses, case managers, UM/QM Manager(s), and Medical Directors to ensure system inputs of manual referrals are processed, timely, accurately and within production standards.
Receives and enters appropriate information from referrals.
Produces daily concurrent review logs to review with nursing staff, UM/QM Manager, and Medical Director/Chief Medical Officer.
Updates, maintains and notifies health plans of inpatient census information on a daily basis.
Updates and submits appropriate logs and reports to health plans (i.
e.
, face sheets, denials, daily inpatient census reports and additional information as instructed).
Assists with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding member concerns/complaints.
Creates, approves, and modifies referrals in accordance with established guidelines.
Obtains appropriate information for authorization request and enters appropriate information.
Verifies member eligibility by systems inquiry or health plan contact.
Requests clinical records per procedure.
Demonstrates a comprehensive knowledge of Health Plan Benefits, DOFR, and the various departmental functions.
Accurately applies appropriate policies, procedures, and eligibility and benefit policies.
Maintains current knowledge of provider network as it continues to develop and change.
Leads projects assigned by designing and effective process, conducting the necessary research to put together and implement an effective project plan to, monitor and implement department and cross-functional projects.
Effectively manages projects and objectives in a timely manner.
Develops positive and professional working relationships with providers, nurses, case managers, and Medical Directors to ensure system inputs of electronic and manual referrals are processed, timely, accurately and within production standards.
Adheres to company policies, procedures, guidelines and directives.
Recognizes and enforces company security measures, maintains strict confidentiality and complies with HIPPA standards.
Enhances professional growth and development through in-service meetings and educational programs.
Assist department in identifying opportunities for workflow improvements.
Contributes to a healthy, positive and safe environment while promoting self as a team member.
Maintains strict Confidentiality Performs related duties consistent with the scope and intent of the position.
Regular attendance.
Travel as required.
Other Functions:
Enforces Company policies and safety procedures.
Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
Competencies 2
years utilization management coordination experience is required.
Minimum of 3 years' experience in the medical field is required.
Ability to type a minimum of 45 WPM.
Ability to professionally and efficiently manages intake activities.
Ability to multi-task, problem solve and analyze data in a fast paced environment.
Ability to intervene and diffuse difficult calls.
Demonstrated ability to assess, evaluate and interpret medical information.
Proficiency with computer and standard business software (MS Office applications) and ability to learn in-house and other systems quickly with minimal training.
Excellent communication skills, including both oral and written.
Excellent active listening and critical thinking skills.
Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
Ability to provide and receive constructive job and/or industry related feedback.
Ability to maintain confidentiality and appropriately share information on a need to know basis.
Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
Ability to consistently deliver excellent customer service.
Excellent attention to detail and ability to document information accurately.
Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
Demonstrate commitment to the organization's mission.
Must have mid-level skills in Microsoft software (Word, Excel, PowerPoint).
Must have the ability to quickly learn and use new software tools.
Must have mid-level skills using e-mail applications.
Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
Ability to work independently as well as in a team environment.
Ability to present self in a professional manner and represent the Company image.
Education and Licensure High School Diploma or GED required.
AA degree in related field is preferred.
Medical Assistant/Certified preferred.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
0 Sacramento, CA Sacramento, CA Full-time Full-time $18 - $22 an hour $18 - $22 an hour 2 days ago 2 days ago 2 days ago Job
Summary:
UM Coordinator l coordinates and supports activities related to authorization processing for outpatient, inpatient and ambulatory services.
Compiles daily inpatient log; reviews specified UM reports; processes referrals, completes denial letters and performs retro-review coordination.
QM coordination of grievances/activities/QOC, and CCS related activities.
Acts as liaison to the providers' offices and the UM/QM staff.
Provides clerical assistance and prepares reports for the UM/QM Supervisor, Manager and/or Director of Medical Management Essential Job Functions:
Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position.
Answers telephone in a prompt, professional, courteous and helpful manner; screens and directs calls to appropriate staff member or department.
Responds to routine requests and completes customer service tickets daily while maintaining an accurate phone call log.
Receives and processes inpatient notifications within established policies & procedures guidelines, and turnaround time.
Updates and submits appropriate logs and reports to health plans (i.
e.
, face sheets, denials, daily inpatient census reports and additional information as instructed).
Generates denial eligibility letters Effectively works with providers, nurses, case managers, UM/QM Manager(s), and Medical Directors to ensure system inputs of manual referrals are processed, timely, accurately and within production standards.
Receives and enters appropriate information from referrals.
Produces daily concurrent review logs to review with nursing staff, UM/QM Manager, and Medical Director/Chief Medical Officer.
Updates, maintains and notifies health plans of inpatient census information on a daily basis.
Updates and submits appropriate logs and reports to health plans (i.
e.
, face sheets, denials, daily inpatient census reports and additional information as instructed).
Assists with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding member concerns/complaints.
Creates, approves, and modifies referrals in accordance with established guidelines.
Obtains appropriate information for authorization request and enters appropriate information.
Verifies member eligibility by systems inquiry or health plan contact.
Requests clinical records per procedure.
Demonstrates a comprehensive knowledge of Health Plan Benefits, DOFR, and the various departmental functions.
Accurately applies appropriate policies, procedures, and eligibility and benefit policies.
Maintains current knowledge of provider network as it continues to develop and change.
Leads projects assigned by designing and effective process, conducting the necessary research to put together and implement an effective project plan to, monitor and implement department and cross-functional projects.
Effectively manages projects and objectives in a timely manner.
Develops positive and professional working relationships with providers, nurses, case managers, and Medical Directors to ensure system inputs of electronic and manual referrals are processed, timely, accurately and within production standards.
Adheres to company policies, procedures, guidelines and directives.
Recognizes and enforces company security measures, maintains strict confidentiality and complies with HIPPA standards.
Enhances professional growth and development through in-service meetings and educational programs.
Assist department in identifying opportunities for workflow improvements.
Contributes to a healthy, positive and safe environment while promoting self as a team member.
Maintains strict Confidentiality Performs related duties consistent with the scope and intent of the position.
Regular attendance.
Travel as required.
Other Functions:
Enforces Company policies and safety procedures.
Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
Competencies 2
years utilization management coordination experience is required.
Minimum of 3 years' experience in the medical field is required.
Ability to type a minimum of 45 WPM.
Ability to professionally and efficiently manages intake activities.
Ability to multi-task, problem solve and analyze data in a fast paced environment.
Ability to intervene and diffuse difficult calls.
Demonstrated ability to assess, evaluate and interpret medical information.
Proficiency with computer and standard business software (MS Office applications) and ability to learn in-house and other systems quickly with minimal training.
Excellent communication skills, including both oral and written.
Excellent active listening and critical thinking skills.
Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
Ability to provide and receive constructive job and/or industry related feedback.
Ability to maintain confidentiality and appropriately share information on a need to know basis.
Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
Ability to consistently deliver excellent customer service.
Excellent attention to detail and ability to document information accurately.
Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
Demonstrate commitment to the organization's mission.
Must have mid-level skills in Microsoft software (Word, Excel, PowerPoint).
Must have the ability to quickly learn and use new software tools.
Must have mid-level skills using e-mail applications.
Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
Ability to work independently as well as in a team environment.
Ability to present self in a professional manner and represent the Company image.
Education and Licensure High School Diploma or GED required.
AA degree in related field is preferred.
Medical Assistant/Certified preferred.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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