Coordinator - Utilization Management Inpatient (Weekends)

Position Summary/Position

Under the general direction of the Inpatient Nurse Supervisor and Manager and collaboration with the Inpatient Clinical Team, the Inpatient Coordinator, is a high paced position that requires timely processing of incoming inpatient admission and discharge information as well as timely processing of inpatient service requests as requested by Utilization Management Nurses. This position requires that one be organized with the ability to multitask with a working knowledge of ICD.10, CPT Coding and Medical Terminology. The Inpatient Coordinator will demonstrate the ability to work as an extension of the clinical team to complete all non-clinical functions as indicated.

Major Functions (Duties and Responsibilities)

1. Responsible for monitoring the Right Fax server, EDI Interface, and medical management system intake to all face sheets are processed in a timely manner.
2. Responsible for ensuring that hard copy and electronic face sheets are complete and accurate to reflect current Member demographic information.
3. Responsible for daily review of the daily census report in an effort to eliminate duplicates or other admission received from all contracted and non-contracted facilities not required by the health plan.
4. Responsible for the approval of service requested within the Inpatient Coordinator scope as indicated by the Utilization Management Guide approved by the Utilization Management Subcommittee.
5. Responsible for obtaining member discharge dates through daily calls or memo submissions to contracted and non-contracted facilities.
6. Responsible for meeting the performance measurement standards for productivity and accuracy as well as timely processing of inpatient authorizations, inpatient service requests, and discharges.
7. Responsible for ensuring that Members receive Home Health or Durable Medical Equipment (DME) items as ordered via phone call and documentation of call within the medical management system.
8. Responsible for representing the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
9. Communicate with providers/facilities in consultation with the Utilization Management Nurse, regarding authorizations, orders, and clinical reviews.
10. Assist and provide support to Management or Inpatient Clinical Team as requested.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Minimum of three (3) years of experience as a data entry specialist.

Preferred Experience

Data entry specialist experience preferably in an HMO or Managed Care setting.  Utilization Management experience preferred.

Education Qualifications

High school diploma or GED required.

Preferred Education

Associate's degree from an accredited instituion preferred.

Professional Certification

Professional Licenses

Drivers License Required

Knowledge Requirement

Requires knowledge of ICD-9/10 and CPT codes. Knowledge of utilization management in a health care delivery setting preferred. Managed Care or physician office a must.

Skills Requirement

Skilled with computer applications, including word processing, database, and spreadsheets.  Good customer service skills.

Abilities Requirement

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

Word processing and data entry involving computer keyboard and screens, distribution of reports, filing and copying of records and/or correspondence.

Position is eligible for telecommuting/remote work location model upon completing the necessary steps and receiving HR approval. The incumbent approved to telecommute may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership.

Work Model Location

Physical Requirements