CM Care Coordinator in Pasadena, California at Imperial Management Administrators Services Inc

JOB DESCRIPTION

JOB TITLE: UM Coordinator FLSA STATUS: Non-Exempt

DEPARTMENT: Utilization Management

REPORTS TO: Supervisor, Utilization Management

JOB SUMMARY: This position processes authorizations and ensures that all information is correct before submitting for approval. All authorizations should be entered within a timely manner with complete data, as well as, all the documents that will support medical necessity. The UM Coordinator will need to have strong written/communication skills in order to provide Medical Director, providers, and members necessary information to ensure the delivery of high-quality effective healthcare.

ESSENTIAL JOB FUNCTIONS:

1. Open and process UM incoming faxes periodically throughout the business day.

2. Answer phones: Providing customer service to calls from providers and/or members.

3. Print approvals and modification letters from the database on a daily basis.

4. Scan any faxes to existing authorizations in the system.

5. Route medical reviewer's cases to appropriate personnel in timely manner on a daily basis.

6. Verify duplicate requests and call/notify doctor's office of referral request cancellations.

7. Contact and follow up with providers on pending clinical/documents within the turnaround time. (Routine 5 days, Urgent 72 hours).

8. Verify and update all missing information (DOS, POS, outpatient or inpatient) before submitting for approval.

9. Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.

10. Maintains regular and consistent attendance.

11. Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

1. Takes on special projects as needed.

2. Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

1. Continuous Learning:

a. Attends staff meetings as required.

b. Attends appropriate training, seminars and workshops as required

2. Customer Focus:

a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff.

3. Quality/Process Improvement/Safety

a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.

b. Supports and demonstrates safety throughout all duties performed.

c. Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

· High school graduate or equivalent.

· 1 year of experience required

· Must have experience in making outgoing phone calls as well as taking incoming phone inquiries

SKILLS/KNOWLEDGE/ABILITY:

· Proficiency in Microsoft Suite and computer use

· Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to residents and staff.

· Willingness and ability to follow written and verbal direction in English.

· Willingness and ability to maintain appropriate level of confidentiality and privacy.

· Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.

· Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.

· Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.

· Ability to effectively prioritize items/tasks as required.

· Willingness and ability to take initiative and be a self-starter.

· Willingness and ability to understand and comply with Federal, State, and local regulations.

LICENSURE/CERTIFICATE/TRAINING:

· n/a