Utilization Management Coordinator

Provides assistance to CCHP Medical Management Department in all stages of authorizations, tasks, and workflows.

• Verifies member eligibility, enrollment, Evidence of Coverage, plan codes, and Explanation of Benefits.
• Prepares and completes authorization forms for review.
• Assures timely, organized processing of inpatient and outpatient authorizations for input into the core computer system.
• Utilizes fax and telephone contacts to obtain information (clinical and non-clinical) from physicians, families and facilities and reports information to UM nurses/medical director requested.
• Processes denials for non-coverage ensuring that the proper letterhead, template and version is used and the proper denial language is used in compliance with current regulations, policy and procedures.
• Serves as back up to all additional Utilization Management Assistants.
• Scans authorizations, notices of non-coverage and other UM documents for filing.
• Follows guidelines, reports suspected violations of any statute compliance with regulations, agreements or guidelines applicable to all health programs or TPA programs.
• Files all related authorization documents in appropriate electronic folders and core system.
• Participates in UM audits as requested.
• Communicate authorization decisions via phone or fax with members and/or providers.
• Accepts and performs other duties as assigned.

• High School degree required
• College level courses preferred
• Medical terminology preferred
• Must communicate clearly with physician office staff to explain requirements and criteria for authorization requests.
• Polite, personable and professional telephone etiquette
• Fluent in English – written and spoken.
• Chinese speaking – Cantonese/Mandarin preferred

• Able to lift up to 30 pounds
• Use proper body mechanics when handling equipment
• Standing, walking and moving 50% of the day.

Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.

Starting at $54,662 – $81,931 per year

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.