Case Management Coordinator - Inpatient Specialty Program
Posted on: August 6, 2022
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
- Supervises the Fax Inbox and appropriately distributes incoming
faxes. Ensures that internal compliance security measures are
- Verifies member eligibility before processing
- 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
- Documents all patient specific information in appropriate
- Assists in verifying health plan benefits and coordinating
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
Business Entity:Medical Network
Job Category:,Patient Services,Patient Services
Job Specialty:Case Management
Shift Length:8 hour shift
Keywords: CEDARS-SINAI, Alhambra , Case Management Coordinator - Inpatient Specialty Program, Executive , Alhambra, California
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