Coordinator - Utilization Management Inpatient-Weekends (Remote)

Date: Nov 24, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 6062 

 

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 multi task 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.

 

This position has a modified work scheduled of Friday - Monday, 9am - 6:00pm, to include Holidays that fall in this work schedule.

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 facesheets 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.

Supervisory Responsibilities

Leading: Self

Experience Qualifications


Minimum of three 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.

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.

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.

 

Starting Salary: $38,563.20  - $45,302.40  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles