Utilization Coordinator - Full-Time

Job Description

Responsibilities

Join the Southwest Healthcare Team!

About Us :

Creating Health and Harmony, Southwest Healthcare is a comprehensive network of care with convenient hospital and ambulatory care / outpatient locations here to serve the Southern California community.

With over 6, passionate providers and healthcare employees, our shared goal is to provide convenient access to a wide range of healthcare services in a way that benefits you, your family, and the entire community.

Job Summary :

The Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time Utilization Coordinator who will supports the Centralized Utilization Review department and collaborates with staff across the Southern California Region.

Duties include but not limited to :

• Outreach to payers via phone or fax for authorization / denial outcomes.
• Accesses payer portals daily to retrieve authorizations / denials and records outcomes.
• Reconciles all payer correspondences and runs daily department reports, taking action if needed.
• Run daily department reports and take action if needed.
• Enter all denials received into Artiva, manage worklist, and facilitate peer to peer.
• Maintains Medi-Cal TAR logs and audits, accesses Medi-Cal portal to submit required documents.
• Retrieves and delivers messages from Utilization Review Dept phone review line at least 4 times per day.
• Answers telephone professionally and courteously.
• Performs other related duties as requested by the UM Manager.

Qualifications

Experience / Training / Experience :

• High School Graduate or equivalent required.
• Two (2) years of administrative experience in a healthcare setting required. Utilization management, managed care, or related role preferred.

Certifications / Licenses :

None

Other Skills and Abilities :

• Demonstrates knowledge and ensures compliance with the Nurse Practice Act, The Joint Commission and Title standards and guidelines.
• Demonstrates compliance with healthcare policies and procedures at all times.
• Demonstrates strong leadership, organization, communication and interpersonal skills.
• Demonstrates ability to relate to clinical personnel and medical staff, as well as ability to interact well with the public.
• Must have knowledge of PC and applications.
• Ability to demonstrate effective written and verbal communication skills.
• Computer skills desirable.
• Ability to respond to any communication required by telephone.

Benefit Highlights :

• Challenging and rewarding work environment.
• Competitive Compensation & Generous Paid Time Off.
• Excellent Medical, Dental, Vision and Prescription Drug Plans.

K) with company match and discounted stock plan.

• SoFi Student Loan Refinancing Program.
• Tuition, CEU, Certification, Licenses Reimbursement program.
• Career development opportunities within UHS and its + Subsidiaries!

Southwest Healthcare is owned and operated by subsidiaries of , a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.

UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or e-mails.

All resumes submitted by search firms to any employee at UHS; via e-mail, the Internet or in any other form and / or method without a valid written search agreement in place for the above-listed position will be deemed the sole property of UHS.

No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.