6 Utilization Management Coordinator Jobs in Monterey, CA
Astrana Health is Hiring an Utilization Management Coordinator Near Monterey, CA
- Comply with UM policies and procedures. Annual review of selected UM policies.
- Read and understand NMM UM Customer Service Policy and Procedures
- Answer incoming calls from providers both contracted and non-contracted. (Average 60 calls)
- 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
- High School Graduate or equivalent
- A minimum of two years experienced in managed care environment to include but not limited to an IPA or MSO preferred
- Current knowledge of Managed Care UM procedures
- Knowledge of medical terminology, RVS, CPT, HPCS, ICD-9 codes
- Proficient with Microsoft applications and EZCAP
- Good organizational skills, verbal and written communication skills
- Must have the ability to multitask and problem solve in a fast pace work environment
- Punctuality, precision with details, creativity, etc. would be helpful for this position
- Ability to follow directions and perform work independently according to department standards
- Must be a strong team player, punctual and have excellent attendance record.
- Patients First
- Empowering the Independent Provider
- Be Innovative
- Operate with Integrity & Deliver Excellence
- Team of On
- Our organization follows a hybrid work structure where the expectation is to work both in the office and at home on a weekly basis. The office is located at 1600 Corporate Center Drive in Monterey Park, CA.
- The total compensation target pay range for this role is $18 - $26 per hour. This salary expectation reflects our national target range for this role.
Job Summary
Full Time
$89k-111k (estimate)
04/06/2024
06/05/2024
The job skills required for Utilization Management Coordinator include Customer Service, Confidentiality, Written Communication, Integrity, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Management Coordinator. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Management Coordinator. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Management Coordinator positions, which can be used as a reference in future career path planning. As an Utilization Management Coordinator, it can be promoted into senior positions as a Clinical Outcomes Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Management Coordinator. You can explore the career advancement for an Utilization Management Coordinator below and select your interested title to get hiring information.
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