UTILIZATION MANAGEMENT COORDINATOR

Accountable Health Plan MSO in Signal Hill has been in operation for 14 years and is seeking to fill the Authorization Coordinator position. This person will be entering, processing and tracking authorizations/referrals. Prior experience in utilization management preferred. Very competitive compensation and benefit packet.  Prior managed care experience preferred. Fax resume to (562) 216-5420 or email it to kmutter@ahcipa.com .

 

Job Description

 

Job Title: Authorization Coordinator

Department:    Utilization Management

Reports to:  UM ManagerPosition Summary

 

To ensure medically necessary care is delivered in the most cost-efficient setting for members who require extensive or ongoing services. To coordinate resources and appropriate cost effective alternatives for catastrophically, chronically ill or injured members on a case-by-case basis to facilitate the achievement of treatment goals. Positions at this level require specialized knowledge, abilities, skills and experience and exercise independent judgment in determining program eligibility, assessing needed services and maintaining compliance with applicable laws and guidelines.Education & Experience requirements:

 

ü  Basic computer data entry skills

ü  Excellent customer service skills

ü  Working knowledge of ICD9 and CPT codingAccountability / Duties / Responsibilities:

 

ü  Enter and process referrals

ü  Assist in identifying potential CCS (California Children’s Services) eligible conditions

ü  Communication with provider office staff to obtain medical records required for medical necessity review

ü  Maintains communication with the health plans to obtain authorization tracking numbers if required.

ü  Other duties, as assigned