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    Utilization Management Coordinator - Sacramento, United States - Pacific ExecSearch

    Pacific ExecSearch
    Pacific ExecSearch Sacramento, United States

    2 days ago

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    Description
    Job Description

    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.
    Meet Your Recruiter

    Karleen Rocheleau

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