What are the responsibilities and job description for the UTILIZATION MANAGEMENT COORDINATOR I MSO position at NORTH EAST MEDICAL SERVICES?
Job Details
Job Location: Burlingame, CA
Education Level: 2 Year Degree
Salary Range: $38.00 - $38.00 Hourly
Description
The Utilization Management Coordinator I functions under the direct supervision of a physician or Registered Nurse, performing utilization management (UM) and care coordination duties for the NEMS MSO.
ESSENTIAL JOB FUNCTIONS:
- Review daily all incoming Referral Requests and Treatment Authorization Requests for inpatient and outpatient services.
- Process and approve authorization requests according to the NEMS MSO Authorization Grid and to established clinical guidelines.
- Must meet the quantitative productivity standard of 250 authorizations per week for the outpatient UM Coordinator and 115 authorizations per week for the inpatient UM Coordinator.
- For complex cases, research additional relevant clinical guidelines from different sources.
- Responsible to prepare and present complex cases to Medical Director for review; confirm Medical Director’s approval/modification/denial decision for record tracking.
- Perform Care Coordination activities with members, families, specialists, and ancillary providers for authorized services.
- Perform customer service for UM inquiries to Primary Care Physician, specialist, and members.
- Stay current with DHCS regulations, Health Plan agreements, and Industry Standard guidelines applicable to healthcare programs.
- Communicate UM related information and updates to all members of the health care team, patients, and their families.
- Follow the appropriate turnaround timeframe for decisions and notification of members and providers.
- Performs other job duties as required by manager/supervisor.
Qualifications
QUALIFICATIONS:
- Completion of a 2-year degree or higher.
- Knowledge of medical terminology.
- Completion of a recognized Medical Assistant degree or certificate a plus.
- Excellent data entry skills.
- Working knowledge of managed-care a plus.
- Strong communication, analytical, and problem-solving skills.
- Knowledge of community resources and cultural needs.
- Good organization and prioritization skills, outstanding in time management.
- Recent experience in a clinic or outpatient setting desirable; able to perform efficiently and appropriately in a busy environment.
LANGUAGE:
- Must be able to fluently speak, read and write English.
- Fluent in Chinese (Cantonese and/or Mandarin) preferred.
- Fluent in other languages is an asset.
STATUS:
- This is an FLSA Non-exempt position.
- This is not an OSHA high-risk position.
Salary : $38