Utilization Management Coordinator

Target Compensation Range: $27.00 - $31.00/hour, depending on the level of relevant qualifications and experience. About Us Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. ESSENTIAL DUTIES AND RESPONSIBILITIES Understands and follows Utilization Management Policies and Procedures pertaining to the referral process. Processes Prior Authorization-Referral requests that are received from PCPs and/or Specialty Providers. Responds to all incoming calls and/or follows up calls in a timely manner. Performs the necessary research for determining a satisfactory disposition. Voice mail is checked promptly after breaks and lunches. Works with the Membership Management and Claims and contracting Departments on an as needed basis. Documents all applicable notes, reminders, date/time stamps, initials etc. involved with the referral process. Accepts calls from physicians and/or their office staff, as well as health plan inquiries regarding referral status. When needed, performs the necessary research (i.e., tracks down the referral packet, etc.). Is able to achieve and maintain all applicable departmental production standards and goals. When time permits, all staff are expected to assist others within the department to facilitate workflow and the referral process. Verifies that the patient address in EZ-cap corresponds with prior authorization/referral request form. Recognizes health plan types and makes notation of any/all shared risk or other unique payors or providers as directed. Recognizes all referral types as well as level of urgency and performs accurate data entry within productivity standards. Regular and consistent attendance. Other duties as assigned. EDUCATION and/or EXPERIENCE Licensed Vocational Nursing (LVN) preferred. High school diploma or equivalent required. 2+ years of experience in a medical office or health plan environment. Current knowledge of medical coding and medical terminology. Strong computer skills and proficiency in word processing. Detail oriented, able to function under pressure and perform multi-tasks at any given time. Excellent communication skills, verbal and written. Fluent in Vietnamese (verbal and written). BENEFITS 401(k) Health Insurance Life Insurance Vision Insurance Paid Time Off LANGUAGE Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups and customers or employees of the organization. MATHEMATICS Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. REASONING ABILITY Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. EEO/AFFIRMATIVE ACTION STATEMENT It is the policy of Astiva Health to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. This policy relates to all phases of employment, including but not limited to recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company sponsored employee activities. Provisions in applicable laws providing for bona fide occupational qualifications, business necessity or age limitations will be adhered to by the organization where appropriate. Please refer to Standard Operating Procedure 100 for more information about the organization’s affirmative action/EEO statement. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit and complete work while on a computer. The employee occasionally is required to stand, walk, use hands to finger, handle or feel, reach with hands and arms, stoop, kneel, crouch or crawl, climb or balance, talk and hear. While performing the duties of this job, the employee is occasionally required to lift or exert force up to 10 pounds. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. #J-18808-Ljbffr