Utilization Management Intensive Case Management Coordinator - After Hours

at  UCLA Health

Description
Take on a vital role within a leading health organization. Help ensure smooth and efficient case management processes to support quality care. Take your expertise to the next level. You can do all this and more at UCLA Health.

Under the direction of the Utilization Management, Assistant Manager, you will play a key role in processing and managing authorization requests. You will:

• Receive urgent, routine, pre-service, and retro authorization requests
• Process referrals and authorizations following established procedures within the medical group utilization department
• Prepare and process referrals according to Delegation of Financial Responsibility (DOFR), UCLA Medical Group Medical Guidelines, and health plan contracts
• Identify and prepare necessary documents for the next level of review
• Maintain and prepare specific reports and manage computer applications and logs
• Monitor members/patients followed by Case Management
• Work directly with a nurse team lead
• Review pending claims for approval or denial

Salary Range: $34.37- $47.31/hourly
Qualifications

We’re seeking a detail-oriented and organized professional with:

• High school diploma, GED, or equivalent
• Experience working in a Managed Care environment, highly desired
• Experience processing ambulatory managed care referrals, preferred
• Proficient computer skills with working knowledge of Microsoft Excel and Word
• Ability to operate a variety of office equipment, including computers, printers, copiers, fax machines, scanners, and mailing equipment
• Ability to multi-task, work with frequent interruptions, and meet deadlines
• Strong attention to detail, organization, and ability to follow directions
• Clear and concise communication skills, both written and verbal
• Familiarity with Vodavi phone system
• Ability to lift up to 25 pounds

• Receive urgent, routine, pre-service, and retro authorization requests
• Process referrals and authorizations following established procedures within the medical group utilization department
• Prepare and process referrals according to Delegation of Financial Responsibility (DOFR), UCLA Medical Group Medical Guidelines, and health plan contracts
• Identify and prepare necessary documents for the next level of review
• Maintain and prepare specific reports and manage computer applications and logs
• Monitor members/patients followed by Case Management
• Work directly with a nurse team lead
• Review pending claims for approval or denia