Coordinator-Managed Care - Redlands, United States - Loma Linda University Medical Center

Description

Job Summary:
The Coordinator-Managed Care works under the supervision of Manager Managed Care. Provides LLEAP Tapestry training to LLUHC Departments. Tracks Bed Day activity, admits, discharges, and Emergency Room services. Approves referral requests within the scope of position, according to health plan criteria and health plan benefit. Arranges for approved home services. Prepares all utilization management (UM) reports. Communicates with out of network facilities. Prepares data required for UM Audits. Cross covers all key areas of utilization management to ensure compliance with regulations. Performs other duties as needed.


Education and Experience:
Minimum five years of managed care experience either with a medical group or a managed care organization, with three years focused in utilization management, health plan criteria and benefit interpretation, authorization determination, and all aspects of health plan UM audits required. Must attain a status of LLEAP Tapestry Credentialed Trainer (CT) status within 90 days of starting position, and maintain.


Knowledge and Skills:
Knowledge of medical terminology, medical diagnosis and diagnostic procedures required. Knowledge of healthcare regulatory requirements; thorough understanding of all aspects of the current managed care environment. Able to keyboard 40 wpm. Able to use a computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to work calmly and respond courteously when under pressure; collaborate and accept direction. Able to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.


Licensures and Certifications:
None

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