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Case Management Coordinator - Inpatient Specialty Program

Company: CEDARS-SINAI
Location: Alhambra
Posted on: August 6, 2022

Job Description:

The Case Management Coordinator, Utilization Management, provides support to the utilization review process. Works collaboratively with all team members of Utilization Management, Patient and Provider Services, Claims Department and other Care Coordination Department staff. Assists in identifying, tracking and coordinating services for patients when needed. The position requiresgood written and communication skills and the ability to interact with Medical Directors, Providers, Medical Group and IPA's to ensure the delivery of high quality, cost effective healthcare and aligned with all state and federal regulations and guidelines.Job Duties and Responsibilities:

  • Enters data and processes referral authorization requests, to include appropriate coding and quantities.
  • Answers incoming calls from Providers, IPAs, Medical Groups and other internal and external calls and assists on the queues as needed.
  • Supervises the Fax Inbox and appropriately distributes incoming faxes. Ensures that internal compliance security measures are met.
  • Verifies member eligibility before processing authorizations.
  • Contacts facilities identified by the UM Nurses/Manager/Director/Medical Director to research any issues (i.e. contract, discharges, services provided).
  • Identifies non-contracted providers and requests Letter-of-Agreements when requested.
  • Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors, or Management.
  • Processes Extensions and Denial Letters, when needed.
  • Prepares Utilization Review Reports as needed.
  • Assists the Case/Care Managers in coordinating and arranging services for members.
  • Provides assistance to the Claims Department, when requested.
  • Documents all patient specific information in appropriate information systems.
  • Assists in verifying health plan benefits and coordinating ambulatory services.
    Education:High school diploma/GED required.Experience:One (1) year healthcare experience. A general knowledge of medical terminology and experience with community resources and social supports required. -One (1) year previous utilization management or managed care experience highly preferred.
    Working Title:Case Management Coordinator - Inpatient Specialty Program
    Department:MNS ISP
    Business Entity:Medical Network
    Job Category:,Patient Services,Patient Services
    Job Specialty:Case Management
    Position Type:Full-time
    Shift Length:8 hour shift
    Shift Type:Day

Keywords: CEDARS-SINAI, Alhambra , Case Management Coordinator - Inpatient Specialty Program, Executive , Alhambra, California

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