Utilization Management Resource Coordinator - San Diego
1 week ago
Job Summary
This position supports the system centralized utilization management department to meet division and organizational objectives, facilitate effective communication between department staff and internal external customers including business office revenue cycle physicians payers.Responsibilities
- Monitor Utilization Management Queues Works with other members of UM team to monitor timely management of UM queues Escalates to management when queues are outside established turnaround timeframes Verifies current insurance plan eligibility Assists UM CMs to report inaccurate insurance information on facesheet Reviews patient list prioritizes/plans for day Contributes continuous improvement initiatives of system centralized utilization management team delivers quality interventions in timely manner Maintains proactive communications with insurance representatives UM CMs TP CM teams at site level Maintains current payer contact list support utilization management activities Maintains passwords access payer portals ensure timely UM authorization capture
- Teamwork Collaboration Acts facilitator between payors UM team members Ensures UM team members updated daily thought out day needed Keeps ICM UM Leadership aware inability complete assigned duties tasks Responsible timely accurate retrieval appropriate action on departmental phone messages necessary faxcommunication Work closely revenue cycle ensure latest reimbursement contract information available utilization managers Work closely revenue cycle make sure all aware real time denials Supports staff leadership meet department objectives
- Database Management Assists processing letters authorization appeal denial Prepare databases written reports leads manager director timely manner requested within scope work Initiates participates creation development forms lists Assist case managers physician advisors denial cases setting peer peer reviews needed Must demonstrate attention detail accuracy
- Department Operations Ensures staff have appropriate resources information expedite smooth transition continuum optimize third party payer reimbursement Monitor authorization patients house ensure reimbursement payment correct level care Monitor completion retro reviews notifies lead reviews pending noon second business day request Provide needed documentation Medi-Cal TAR free process complete TARs timely patients accepted hospice admitted inpatient Attends department meetings Initiates participates huddles quality improvement activities All work consistently completed time
Job description
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