The Judge Group is looking for a UM Coordinator in Corona, CA!
- The Utilization Management (UM) Coordinator is responsible for general, precertification, concurrent and/or retrospective review of inpatient and/or outpatient services. The Utilization Management Coordinator is responsible for data entry of incoming requests, efficient and immediate processing of authorization requests and prepping those requests for nurse review as indicated by pre-determined business rules. Works with providers, provider office staff, health plans and other internal and external customers to meet the health care needs of members with the appropriate resources.
Essential Job Functions:
- Maintain a positive work and team environment
- Assist other staff that supports the team approach.
- Verify eligibility, benefits and address other referral request related services from providers and their office staff.
- Maintain turnaround time compliance in all aspects of the Prior Authorization and regulatory process.
- Data entry of faxed referrals and review for coordinator level for approval
- Review the portal referrals for coordinator level for approval
- Request notes from provider for review when needed.
- Identify “carve out” services and coordinate care with provider for member access to care.
- Process special reports assigned.
- Recognize when an error has been made and immediately report to appropriate manager.
- Perform professional customer service and efficient problem solving for all health services related calls.
- Return phone calls to providers and follow up with request in a timely fashion.
- Assist in training when assigned
- Communicate effectively in written in Xpress diary and / or verbally and interact with the providers, and or health plans as indicated
- Uphold health services process according to the policy and procedures.
- Adhere to all company policy and procedures.
- Complete daily work assigned.
- Perform other duties as assigned.
Please send your most up to date resume to Jaclyn at Jrossillo@judge.com