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Utilization Management Coordinator

Location
San Francisco Bay Area

Employment Type
Full-Time (Hybrid)

Position Summary
Provides assistance to CCHP Medical Management Department in all stages of authorizations, tasks, and workflows.

Essential Duties & Responsibilities
Verifies member eligibility, enrollment, Evidence of Coverage, plan codes, and Explanation of Benefits.
Prepares and completes authorization forms for review.
Assures timely, organized processing of inpatient and outpatient authorizations for input into the core computer system.
Utilizes fax and telephone contacts to obtain information (clinical and non-clinical) from physicians, families and facilities and reports information to UM nurses/medical director requested.
Processes denials for non-coverage ensuring that the proper letterhead, template and version is used and the proper denial language is used in compliance with current regulations, policy and procedures.
Serves as back up to all additional Utilization Management Assistants.
Scans authorizations, notices of non-coverage and other UM documents for filing.
Follows guidelines, reports suspected violations of any statute compliance with regulations, agreements or guidelines applicable to all health programs or TPA programs.
Files all related authorization documents in appropriate electronic folders and core system.
Participates in UM audits as requested.
Communicate authorization decisions via phone or fax with members and/or providers.
Accepts and performs other duties as assigned.

Qualifications
High School degree required
College level courses preferred
Medical terminology preferred
Must communicate clearly with physician office staff to explain requirements and criteria for authorization requests.
Polite, personable and professional telephone etiquette
Fluent in English – written and spoken.
Chinese speaking – Cantonese/Mandarin preferred

Physical requirements
Able to lift up to 30 pounds
Use proper body mechanics when handling equipment
Standing, walking and moving 50% of the day.

Base Pay Scale
Starting at $54,662 – $81,931 per year
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

Time:  Full time
Salary:  Hourly
Category:  Clinical/pharmacy/quality

Updated: 2/6/2024 6:47:22 PM