Utilization Management Coordinator - Remote
The Utilization Management Coordinator is responsible for supporting clinical, management, and client activities, comprising the UM Program. The Utilization Management Coordinator understands all UM processes such as pre-authorizations, retro reviews, Division of Financial Responsibilities and Health Plan contracts. The UM Coordinator will ensure we are processing quality referrals in a timely manner meeting the health plan standards.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- Comply with UM policies and procedures. Annual review of selected UM policies.
- Read and understand NMM UM Customer Service Policy and Procedures
- Process Routine & Urgent treatment authorization requests according to the NMM Policy & Procedure Manual based on UM Level 1 review process.
- Assist with attaching incoming notes to appropriate authorizations
- Move referrals coming back from eligibility and or benefits to the correct queue for review
- Accurately review, screen and process daily assigned UM referrals (avg 150-250) in accordance with IPA and health plan TAT guidelines
- Responsible for verification to include but not limited to: benefit matrix through DOFR, eligibility, provider status (contracted/non-contracted), carved out and others.
- Contact providers office as needed for clarification, notes or redirections
- Verify that facilities are contracted and or a CMS approved facility when required.
- Attend to provider and interdepartmental calls in accordance with exceptional customer service
- Reports to UM Lead 3 on activities or problems occurring throughout the day.
- Maintains strictest confidentiality at all times.
- Maintain good relationships with health plans and medical directors and external contacts.
- Team skills, assist others as needed in order to comply with TAT.
- Other duties as assigned
Qualifications
- High School Graduate, Bachelor's in Healthcare Administration is a plus
- Experience with authorizations or referrals in healthcare
- A minimum of two years experienced in managed care environment to include but not limited to an IPA or MSO preferred
- Knowledge of medical terminology, RVS, CPT, HPCS, ICD-9 codes
- Proficient with Microsoft applications
- Good organizational skills, verbal and written communication skills
- Ability to multitask and problem solve in a fast pace work environment
- Punctuality and detail-oriented
- Ability to follow directions and perform work independently according to department standards
- Must be a strong team player and have excellent attendance record
Environmental Job Requirements and Working Conditions
- This is a remote position. Candidates must reside in California.
- This position will typically work Monday - Friday from 8:00 am to 5:00 pm. There may be up to 1 hour of voluntary OT per day.
- The target pay range for this role is $22.00 - $24.00 per hour. This salary range represents our national target range for this role
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