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Providence Health & Services Utilization Management Coordinator in Torrance, California

Description:

Providence is calling a Full Time, Variable Shift Utilization Management Coordinator to Providence California Regional Services in Torrance, CA.

We are seeking a Utilization Management Coordinator under the supervision of Regional Director of Care Management, who will be responsible for providing support to the Care Management team who coordinates care. This position works closely as a healthcare team member and performs clerical tasks related to the overall team functions and activities identified during the initial and ongoing assessment and management of patients.

The UM Coordinator coordinates with multiple disciplines regarding inpatient notification of an admission and/or patient transfer. Collaborates with physicians, hospital staff, insurance companies, and patient/family. Acts as liaison to facilitate and manage appropriate and timely transfers.

In this position you will have the following responsibilities:

  • Perform insurance verification with focus on authorization, notification, patient liability estimates, superior customer service and high employee satisfaction to ensure placement at appropriate capitated hospital

  • Coordinate with multiple disciplines regarding inpatient notification of an admission and/or patient transfer

  • Collaborate with physicians, hospital staff, insurance companies, and patient/family. Coordinate and acts as liaison to facilitate and manage appropriate and timely transfers

  • Provide and assist physicians with non-emergent transfers, consults, and other calls received

  • Responsible for accurately entering all patient demographic and insurance information into EPIC when creating patient encounter, including authorization information

  • Work collaboratively with the Patient Financial Services staff to insure that face sheets are obtained on all referred patients prior to inpatient admission

  • Provide initial information to registration and case managers of repatriated patients; update all admission records as necessary. Will coordinate non-emergent patient transfer and transport via ground ambulance

  • Ensure clinical reviews and discharge summaries are complete and submitted timely to health plans

  • Oversee the Peer to Peer process to ensure it is completed and documented

  • Track and document concurrent authorizations and pertinent data into the EPIC system as assigned

  • Track and document all placement difficulties and delays in obtaining post-acute authrorizations (Durable Medical Equipment, Home Health, Skilled Nursing Facility)

  • Own and resolve accounts contained in the associated CM EPIC WQs to ensure timely billing

  • Coordinate authorization/referrals based upon business rules, payor/government regulations, complexity of patient, care management admission

  • Monitor and follow up on Clinical Reviews and Over Approved Days Workque

  • Document communication and receipt of information, from all members of the healthcare team, including payors and post-acute providers as required

  • Responsible for administrative functions as it relates to faxing and obtaining clinical documentation for approved bed day hospitalization requirements

  • Assist in determining appropriate coverage including hospitalization, DME, out-patient medications and obtaining authorizations as needed

  • Maintain consistent productivity and quality of work in a challenging, fast paced and rapidly changing environment with frequent interruptions

  • Consistently provide superior customer service that meets or exceeds the expectations of patients, visitors, physicians and PH&S staff, including during periods of high patient volumes or stressful situations

  • Perform independently while multitasking, problem solving, and exercising good time management skills in a fast-paced environment

  • Maintain knowledge of numerous complex compliance requirements and insurance plans, which change frequently

Qualifications:

Required qualifications for this position include:

  • H.S. Diploma or GED or High School Diploma or GED equivalent or some college level course work preferred particularly Medical Terminology or Medical Assistance coursework

  • 3 years hospital, clinical setting or healthcare related field

  • Must maintain up-to-date knowledge and competency with numerous federal, state and other regulatory body compliance regulations and third party insurance plans, including: Medicare Secondary Payer, EMTALA, and ABN

  • Demonstrated knowledge of HIPAA rules and regulations

  • Demonstrated knowledge of CPT and ICD10 coding and medical terminology

  • Knowledge of or ability to learn InterQual Guidelines application, Word, Excel, EPIC

  • Appropriate escalation of issues and problems as determined by department protocols. Collaborates with clinical staff to enter notes related to authorization status and requested admissions in EPIC

  • Assists ED Hospital Unit Clerk [HUC] in the dispatch of repatriated transfer and provides insurance authorization information when necessary

  • Ability to establish priorities, organize work, be detail oriented and follow through, particularly due to the financial impact if duties are not performed in a timely and accurate manner

  • Ability to identify and solve complex problems

  • Ability to perform multiple tasks simultaneously and work effectively with interruptions

  • Above average verbal and written communication skills: able to read, write legibly and speak fluently using the English language

  • Demonstrated service excellence with patients, families, sponsors, caregivers and team members

  • A track record in organizing and planning with demonstrated ability to effectively manage time and achieve results in a fast paced environment

  • Demonstrates knowledge of and utilizes electronic and automated work tools (e.g., online access tools to payers, work drivers)

  • Basic knowledge of insurance and managed care payers

  • Collaborating with Manage Care contracting on obtaining, Letter of Agreements, eligibility and benefits as it relates to patients services for the organization

  • Demonstrate compliance with all established policies and procedures as they apply to coordination of patient transfer or discharge

  • Develops a high degree of familiarity with client service area geography and medical facilities

We offer a full comprehensive range of benefits - see our website for details

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Variable

Job Category: Administrative (Non-Clinical)

Location: California-Torrance

Req ID: 243160

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