Utilization Management Coordinator

Job Locations US-CA-Aliso Viejo
Req No.
2018-2327
Category
Clinical/Medical
Type
Contract

Overview

ConcertoHealth delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. For over a decade, we have provided extraordinary outcomes for thousands of people in these underserved groups.

The ConcertoHealth name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. It’s about the harmony of a patient’s care, health, and dignity.

 

The UM Coordinator position is a liaison between the patient and specialty providers and other ancillary services to ensure benefit requirements are met by requesting authorizations.  The UM Coordinator will keep the patient and providers informed during the process. 

 

Responsibilities

  • Performs data entry of referral authorization request for primary care visits, specialty consults, diagnostic/outpatient procedures and admissions approved by the Medical Director
  • Tracks and monitors progress of referral request, responding to request for additional information to assist the clinical staff in making a decision
  • Reviews all incoming referral request for completeness of information provided
  • Obtains CPT procedure codes, ICD-10 diagnosis codes from referring providers to assist with determination of approval/denial
  • Ensures that network providers are utilized
  • Handles incoming calls from physicians, ancillary providers, and patients regarding referral authorization request
  • Monitors and facilitates reauthorization request for home health, DME and other services according to benefit guidelines
  • Coordinates all out of network outpatient referrals to specialist with the Medical Director
  • Generates all required letters and notifications to patients and providers regarding referral authorizations
  • Maintains/updates all required reporting for referrals/authorizations

 

 

 

Qualifications

  • Minimum of 2 years of medical office setting
  • Healthcare insurance plan experience preferred
  • Typing 45wpm
  • High School diploma
  • Excellent written/verbal communication skills, especially the ability to communicate telephonically in a professional and effective manner, especially in stressful situation
  • Computer literacy in MS Word, Excel and Outlook
  • Strong analytical, organizational and time management skills, able to work independently
  • Able to multi-task at once

 

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