Utilization Management Coordinator, Full-Time/Remote

The Utilization Management (UM) Coordinator provides MSO referral management services. The UM Coordinator serves as a liaison between members, physicians, providers, and MSO staff, processing initial intake of information, assisting with authorization functions, and gathering information. Position is responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities, and ancillary providers. The incumbent is responsible for tasks/functions related to the MSO’s prior authorization and referral process including applying the MSO’s criteria and policies/procedures to authorization requests from medical professionals, clinical facilities, and ancillary providers. The UM Coordinator will directly interact with providers, acting as a resource for their needs.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Excellent verbal and written communication skills
• Familiar with EzCap
• Minimum typing speed of 40 wpm.
• Able to prioritize and delegate effectively.
• Attention to details.
• Excellent organizational skills.
• Must be familiar with Health Plan benefit verification
• Must have knowledge of medical terminology
• Proficient in Windows, Microsoft Word, and Excel.
• Develop and maintain effective working relationships with all levels of staff, community agencies, providers, and members.
• Maintain an understanding of current CPT, ICD-10 and HCPCS codes and continual updates to knowledge base regarding the codes.
• Utilize prior authorization protocols to determine when to refer matters to a licensed staff person.

Required Experience

Required:

• High School Graduate or equivalent certification.
• Minimum of two (2) years’ experience in a managed care or health plan environment

Preferred:

• Passed the Bilingual Fluency Assessment for Clinicians (BFAC Certified) by Language Line Solutions