North East Medical Services
Utilization Management Coordinator I Mso
North East Medical Services, Burlingame, California, United States, 94012
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Utilization Management Coordinator I Mso
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North East Medical Services 1 month ago Be among the first 25 applicants Join to apply for the
Utilization Management Coordinator I Mso
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North East Medical Services Job Details
Burlingame, CA 2 Year Degree $34.37 - $38.85 Hourly
Description
SUMMARY OF POSITION:
The Utilization Management Coordinator I functions under the direct supervision of a physician or Registered Nurse, performing utilization management (UM) and care coordination duties for the NEMS MSO.
Essential Job Functions
Review daily all incoming Referral Requests and Treatment Authorization Requests for inpatient and outpatient services. Process and approve authorization requests according to the NEMS MSO Authorization Grid and to established clinical guidelines. Must meet the quantitative productivity standard of 250 authorizations per week for the outpatient UM Coordinator and 115 authorizations per week for the inpatient UM Coordinator. For complex cases, research additional relevant clinical guidelines from different sources. Responsible to prepare and present complex cases to Medical Director for review; confirm Medical Director’s approval/modification/denial decision for record tracking. Perform Care Coordination activities with members, families, specialists, and ancillary providers for authorized services. Perform customer service for UM inquiries to Primary Care Physician, specialist, and members. Stay current with DHCS regulations, Health Plan agreements, and Industry Standard guidelines applicable to healthcare programs. Communicate UM related information and updates to all members of the health care team, patients, and their families. Follow the appropriate turnaround timeframe for decisions and notification of members and providers. Performs other job duties as required by manager/supervisor.
Qualifications
QUALIFICATIONS:
Completion of a 2-year degree or higher. Knowledge of medical terminology. Completion of a recognized Medical Assistant degree or certificate a plus. Excellent data entry skills. Working knowledge of managed-care a plus. Strong communication, analytical, and problem-solving skills. Knowledge of community resources and cultural needs. Good organization and prioritization skills, outstanding in time management. Recent experience in a clinic or outpatient setting desirable; able to perform efficiently and appropriately in a busy environment.
Language
Must be able to fluently speak, read and write English. Fluent in Chinese (Cantonese and/or Mandarin) preferred. Fluent in other languages is an asset.
Status
This is an FLSA Non-exempt position. This is not an OSHA high-risk position. This is a Full Time position.
NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k). Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Project Management and Information Technology Industries Hospitals and Health Care Referrals increase your chances of interviewing at North East Medical Services by 2x Sign in to set job alerts for “Management Coordinator” roles.
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Utilization Management Coordinator I Mso
role at
North East Medical Services 1 month ago Be among the first 25 applicants Join to apply for the
Utilization Management Coordinator I Mso
role at
North East Medical Services Job Details
Burlingame, CA 2 Year Degree $34.37 - $38.85 Hourly
Description
SUMMARY OF POSITION:
The Utilization Management Coordinator I functions under the direct supervision of a physician or Registered Nurse, performing utilization management (UM) and care coordination duties for the NEMS MSO.
Essential Job Functions
Review daily all incoming Referral Requests and Treatment Authorization Requests for inpatient and outpatient services. Process and approve authorization requests according to the NEMS MSO Authorization Grid and to established clinical guidelines. Must meet the quantitative productivity standard of 250 authorizations per week for the outpatient UM Coordinator and 115 authorizations per week for the inpatient UM Coordinator. For complex cases, research additional relevant clinical guidelines from different sources. Responsible to prepare and present complex cases to Medical Director for review; confirm Medical Director’s approval/modification/denial decision for record tracking. Perform Care Coordination activities with members, families, specialists, and ancillary providers for authorized services. Perform customer service for UM inquiries to Primary Care Physician, specialist, and members. Stay current with DHCS regulations, Health Plan agreements, and Industry Standard guidelines applicable to healthcare programs. Communicate UM related information and updates to all members of the health care team, patients, and their families. Follow the appropriate turnaround timeframe for decisions and notification of members and providers. Performs other job duties as required by manager/supervisor.
Qualifications
QUALIFICATIONS:
Completion of a 2-year degree or higher. Knowledge of medical terminology. Completion of a recognized Medical Assistant degree or certificate a plus. Excellent data entry skills. Working knowledge of managed-care a plus. Strong communication, analytical, and problem-solving skills. Knowledge of community resources and cultural needs. Good organization and prioritization skills, outstanding in time management. Recent experience in a clinic or outpatient setting desirable; able to perform efficiently and appropriately in a busy environment.
Language
Must be able to fluently speak, read and write English. Fluent in Chinese (Cantonese and/or Mandarin) preferred. Fluent in other languages is an asset.
Status
This is an FLSA Non-exempt position. This is not an OSHA high-risk position. This is a Full Time position.
NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k). Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Project Management and Information Technology Industries Hospitals and Health Care Referrals increase your chances of interviewing at North East Medical Services by 2x Sign in to set job alerts for “Management Coordinator” roles.
18 Reasons Development Coordinator VISTA
San Francisco, CA $68,000.00-$85,000.00 6 months ago San Francisco, CA $70,000.00-$83,000.00 3 weeks ago Property Management Coordinator (Flex Hybrid)
South San Francisco, CA $31.25-$43.27 10 months ago Property Management Coordinator (Flex Hybrid)
San Francisco, CA $70,000.00-$75,000.00 2 weeks ago San Francisco, CA $35.00-$40.00 2 weeks ago San Francisco, CA $24.04-$32.45 3 weeks ago San Francisco, CA $80,000.00-$90,000.00 2 weeks ago San Francisco, CA $56,160.00-$93,600.00 5 days ago San Francisco, CA $115,000.00-$150,000.00 2 weeks ago South San Francisco, CA $100,000.00-$135,000.00 1 month ago San Francisco, CA $30,000.00-$40,000.00 3 weeks ago San Mateo, CA $80,000.00-$85,000.00 1 week ago San Francisco, CA $123,266.00-$149,734.00 2 weeks ago San Francisco, CA $56,160.00-$93,600.00 2 weeks ago Palo Alto, CA $139,000.00-$184,000.00 2 weeks ago San Mateo, CA $70,000.00-$85,000.00 4 days ago Foster City, CA $75,000.00-$90,000.00 6 hours ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr