UM/QI Coordinator at Verda Healthcare Inc – Huntington Beach, California

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a UM/QI Coordinator to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc. is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview

Verda Healthcare is seeking an organized, detail-oriented Utilization Management (UM), Case Management (CM), and general UM Operations Coordinator to join the UM/QM team. As a coordinator, you will assist with managing census and admissions, UM outpatient request, collection of analytical data, retrieval of medical records, and discharge planning while working with the UM/CM supervisors, managers, and director of healthcare services.

This position reports to the UM Supervisor.

Essential Functions

• Support the UM/CM/QI team to process authorization requests, discharge, transition of care, member resources, and analytical data retrieval and collection.
• Make calls to contracted providers as needed to support UM/CM/QI
• Process all incoming fax/emails/provider portal submission request for services the same day.
• Process provider and member letters (Letter of Agreements, Approvals, Denials etc.).

Responsibilities:

• Triage and assign cases amongst the team on a rotating basis.
• Provide administrative support to UM, CM, and QI departments.
• Respond to providers/vendors regarding pre-authorization requests, and status inquiries.
• Respond to all inpatient notifications (NOA) from providers.
• Attach medical records to authorizations.
• Enter referral requests / authorizations in system using ICD 10 and CPT coding.
• Complete and document tasks assigned by UM director/manager/supervisor.
• Maintain documentation on facilities contacted.
• Assist with mailing or faxing correspondence to facilities.
• Request medical records from facilities, etc., related to members’ inpatient admission as needed.
• Assist with the retrieval/collection, and analysis of analytical data.
• Assist with maintaining and updating member’s records.
• Meet specific deadlines (respond to various workloads by assigning task priorities according to department policies, standards, and needs).
• General support of the UM department or other departments at Verda.

Minimum Qualifications

• 2 years of experienced in managed care with a health plan or IPA
• Good verbal and written communication skills.
• Working knowledge of Microsoft Word, Excel, and Outlook.

Professional Competencies

• High school diploma or general education degree (GED); with one to three months related experience and / or training; or equivalent combination of education and experience.

Minimum Qualifications

• 2 years of experienced in managed care with a health plan or IPA
• Good verbal and written communication skills.
• Working knowledge of Microsoft Word, Excel, and Outlook.

Professional Competencies

• High school diploma or general education degree (GED); with one to three months related experience and / or training; or equivalent combination of education and experience.

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time employment
Location: Huntington Beach, CA

Compensation Range:

$20 - 25 hourly

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.

Benefits:

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental Insurance
• Vision Insurance
• Life Insurance

Schedule:

• Full-time onsite (100% in-office)
• Hours of operations: 9am – 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute to the required office location, or planning to relocate before starting work.

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

*Other duties may be assigned in support of departmental goals.