We are recruiting for a Utilization Management Coordinator (UMC) for an established healthcare organization in Sacramento. The UM Coordinator supports activities related to authorization processing for outpatient, inpatient and ambulatory services. This is a contract to hire opportunity! The ideal candidate has experience with medical referrals, authorizations, health plans and excellent patient customer service. Pay: $18-$21/hour DOE. 

RESPONSIBILITIES:

• Compile daily inpatient log; review specified UM reports.

• Process referrals, generate denial letters and perform retro-review coordination. 

• Acts as liaison to the providers’ offices and the UM/QM staff.  

• Provide clerical assistance and prepare reports for the UM/QM Supervisor, Manager and/or Director of Medical Management.

• Answer telephone; screen and direct 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.

• Receive and enters appropriate information from referrals.

• Update, maintain, and notify health plans of inpatient census information on daily basis.

• Assist with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding member concerns/complaints.

• Verify member eligibility by systems inquiry or health plan contact. 

• Request clinical records per procedure.

QUALIFICATIONS:

• High School Diploma or GED required. AA degree in related field is 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.