The Utilization Management Coordinator provides support to the utilization review process. The coordinator works collaboratively with all team members of Utilization Management, Patient and Provider Services, Claims Department and other Care Coordination Department staff. In addition, the coordinator assists in identifying, tracking and coordinating services for patients when needed. The position requires strong written and communication skills and the ability to interact with Medical Directors, Providers, CSMNS members, Medical Group and IPA's to ensure the delivery of high quality, cost effective healthcare and compliant with all state and federal regulations and guidelines.
Job Duties and Responsibilities:
- Enters data and processes referral authorization requests, to include appropriate coding and quantities
- Answers incoming calls from Providers, IPAs, Medical Groups and other internal and external calls and assists on the queues as needed - Monitors the Fax Inbox and appropriately distributes incoming faxes. Ensures that internal compliance security measures are met - Verifies member eligibility before processing authorizations - Identifies non-contracted providers and requests Letter-of-Agreements when requested - Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors, or Management - Processes Extensions and Denial Letters, when needed. - Monitors the Turn Around Timeframes - Contacts facilities identified by the UM Nurses/Manager/Director/Medical Director to research any issues (i.e. contract, discharges, services provided). - Prepare Utilization Review Reports as necessary. - Assists the Case/Care Managers in coordinating and arranging services for members. - Assists the Claims Department, when requested - Responds to variations in daily workload by evaluating task priorities according to department policies and standards. - Maintains confidentiality of information between and among health care professionals. - Other duties as assigned.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major t...eaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.