Utilization Management Coordinator

Title

Compliance Coordinator

Managed Care Health Plan)

Schedule : M-F, 8 : 00 am - 5 : 00 pm, onsite

Pay : $34.00- $41.00

DESCRIPTION

The Compliance Coordinator is a key leadership support position designed to provide, manage, and document continuous compliance and regulatory activities within the department.

This individual will be responsible for the ongoing monitoring and analysis of clinical performance, to assist in the design and implementation of improvement initiatives within medical management.

This position is part of a compliance team, reporting to the Compliance Director, and works closely to ensure that all regulatory and compliance reports and tasks are completed in a timely manner.

• Responsible for the on-going training of the Medical Management staff, in partnership with the UM Manager, to stay in compliance with all regulatory requirements.
• Designs, implements and ensures completion of educational materials and attestations for staff as directed to meet regulatory compliance.
• Works closely with the Director to ensure policies and procedures meet federal and state regulatory requirements.
• Organizes and maintains filing systems and archival records within the shared drives.
• Schedules and prepares for UM delegation audits, gathering evidentiary documents and referral files, in partnership with the Director
• Collaborates with the Director to schedule and prepare for Committee meetings. This includes taking minutes and ensuring that regulatory items and approvals are documented.

Obtains all the necessary signatures to stay in compliance.

• Responds to all appeals for UM referral denials, gathering documents to send to the health plans.
• Back-up for the Denial Coordinator in the writing of all our denial, modification, and carve-out letters
• Works with the other Compliance Coordinator to complete weekly, monthly, quarterly, and yearly regulatory and compliance reports.
• Develops strong and collaborative working relationships with the health plan auditors
• Responsible for working with IT on compliance reports and submitting them timely to health plans
• Responsible for the development and evaluation of the ICE UM Reports and Work Plan
• Conducts internal staff performance audits and Inter-Rater Reliability audits to meet regulatory compliance as it pertains to utilization management activities
• Acts as educator and resource to medical management staff
• Responsible for ensuring that medical management policies are appropriately implemented.

REQUIREMENTS

• Minimum 3-4 years of medical management experience, especially in the area of Utilization Management and Health Plan audits
• Experience in EPIC / Tapestry required.
• Experience with Adobe Acrobat required, beyond basic usage
• Knowledge of clinical and medical terminology
• Advanced computer skills in a Microsoft Window environment, especially Excel and PowerPoint, as well as Visio and various healthcare software programs.
• Bachelor's degree in healthcare administration or a healthcare related field of study

INDH