Job Openings in Sacramento County and Beyond
Utilization Management Coordinator
Sacramento, CA | Temp-to-Hire Position
Responsibilities: Compiles daily inpatient log; reviews specified UM reports. Processes referrals, generates denial letters and performs retro-review coordination. 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. Answers telephone; screens and directs calls to appropriate staff member or department. Effectively works with providers, nurses, case managers, UM/QM Manager(s), and Medical Directors to ensure system inputs of manual referrals are processed, timely and accurately. Receives and enters appropriate information from referrals. Updates, maintains and notifies health plans of inpatient census information on a daily basis. Assists with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding member concerns/complaints. Verifies member eligibility by systems inquiry or health plan contact. Requests clinical records per procedure.
Requirements: High School Diploma or GED required. AA degree in related fieldis preferred. Medical Assistant/Certified preferred. 2+ years utilization management coordination experience is required. Minimum of 3 years' experience in the medical field is required. Type minimum of 45 WPM. Ability to multi-task, problem solve and analyze data in a fast paced environment. Demonstrated ability to intervene and diffuse difficult calls. Proficiency with MS Office applications. Excellent communication skills, both oral and written. Ability to maintain confidentiality and appropriately share information on a need to know basis.