Utilization Management Intensive Case Management Coordinator - After Hours

General Information

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Work Location: Los Angeles, USA

Onsite or Remote

Flexible Hybrid

Work Schedule

Wednesday

• Friday 1:00pm

• 10:00PM PST, Saturday

• Sunday 8:00am

• 5:00pm PST

Posted Date

04/09/2024

Salary Range: $22.03 - 43.68 Hourly

Employment Type

2

• Staff: Career

Duration

Indefinite

Job #

15470

Primary Duties and Responsibilities

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Provide key clinical support within a world-class health organization. Help ensure the delivery of exceptional, compassionate, and appropriate patient care. Take your professional expertise to the next level. You can do all this and more at UCLA Health.

Under the direction and supervision of the RN Assistant Director, the Case Management Coordinator is responsible for patient high risk care coordination activities in hospital, SNF and outpatient settings during afterhours and weekends. The role receives urgent, routine, pre-service and retro authorization requests and processes them through the referral and authorization procedures as established by the medical group utilization department. Responsible for prepping and processing referrals according to DOFR, posted UCLA Medical Group Medical Guidelines, identifies documents needed to assist the next level of reviewer in review, and health plan contracts.

The Case Management Coordinator will also be responsible for:

• Preparation and maintenance of specific reports and computer applications/logs

• Monitoring members/patients followed by Case Management for safe discharge planning and appropriate access to care

• Working directly with Concurrent Nurses and Intensive Case Management Nurses

• Review pending claims for approval or denial

• Provide timely care coordination for CM enrolled patients and Medicare Advantage high risk patients to prevent hospital utilization

Salary Range: $22.03 - $43.68 Hourly

Note: This posted position is 1 of 2 positions available for hire. All applicants will apply through this requisition and if selected will be hired into one of the available positions.

Job Qualifications

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We're seeking a well-organized, detail-oriented, deadline-driven individual with:

• High school diploma, GED, or equivalent

• Experience working in case management and care coordination in managed care environment preferred

• Proficiency in processing ambulatory managed care referrals

• Vodavi phone system experience desired

• Ability to operate a wide variety of office equipment

• Computer proficiency with Microsoft Office

• Excellent communication and multi-tasking skills

• Ability to work well with frequent interruptions and meet deadlines

• Care Coordination experience preferred