Coordinator - Utilization Management Outpatient

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the general direction of the UM Outpatient Manager and Supervisor, the Outpatient UM Coordinator, is a high paced position that requires timely processing of authorization requests, verifying eligibility and obtaining additional information as requested by Medical Management or Utilization Management Nurses.  This position requires that one be organized, ability to multitask with a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The Outpatient UM Coordinator will also ensure that provider calls are responded to in an accurate and timely manner while always maintaining highest level of customer service, in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off- vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities

1.  Responsible for monitoring the Right Fax Server.  Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
2. Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoded referrals.
3. Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.
4. Responsible for representing the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
5. Communicate with providers in consultation with the Utilization Management Nurse, regarding authorizations, modifications, denials, and other matters pertinent to processing authorization requests or other UM related correspondence.
6. Assist Management or Utilization Management Nurses as requested.

Education & Experience

• Minimum of three (3) years of experience as a data entry specialist or coordinator
• High school diploma or GED required

Key Qualifications

• Requires knowledge of ICD-9/10 and CPT codes
• Managed Care or physician office a must
• Skilled in computer applications, including word processing, database, and spreadsheets
• Good customer service skills

Start your journey towards a thriving future with IEHP and apply TODAY!

Telecommute