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Providence Health & Services Utilization Management Coordinator in Torrance, California

Description:

Providence is calling a Part time, Day Shift Utilization Management Coordinator to Providence California Regional Services in Torrance, CA.

We are seeking a Utilization Management Coordinator under the supervision of Regional Director of Care Management, who will be responsible for providing support to the Care Management team who coordinates care. This position works closely as a healthcare team member and performs clerical tasks related to the overall team functions and activities identified during the initial and ongoing assessment and management of patients.

The UM Coordinator coordinates with multiple disciplines regarding inpatient notification of an admission and/or patient transfer. Collaborates with physicians, hospital staff, insurance companies, and patient/family. Acts as liaison to facilitate and manage appropriate and timely transfers.

In this position you will have the following responsibilities:

  • Perform insurance verification with focus on authorization, notification, patient liability estimates, superior customer service and high employee satisfaction to ensure placement at appropriate capitated hospital

  • Coordinate with multiple disciplines regarding inpatient notification of an admission and/or patient transfer

  • Collaborate with physicians, hospital staff, insurance companies, and patient/family. Coordinate and acts as liaison to facilitate and manage appropriate and timely transfers

  • Provide and assist physicians with non-emergent transfers, consults, and other calls received

  • Be responsible for accurately entering all patient demographic and insurance information into EPIC when creating patient encounter, including authorization information

  • Work collaboratively with the Patient Financial Services staff to insure that face sheets are obtained on all referred patients prior to inpatient admission

  • Provide initial information to registration and case managers of repatriated patients; update all admission records as necessary. Coordinate non-emergent patient transfer and transport via ground ambulance

  • Ensure clinical reviews and discharge summaries are complete and submitted timely to health plans

  • Oversee the Peer to Peer process to ensure it is completed and documented

  • Track and document concurrent authorizations and pertinent data into the EPIC system as assigned

  • Track and document all placement difficulties and delays in obtaining post-acute authrorizations (Durable Medical Equipment, Home Health, Skilled Nursing Facility)

  • Own and resolve accounts contained in the associated CM EPIC WQs to ensure timely billing

  • Coordinate authorization/referrals based upon business rules, payor/government regulations, complexity of patient, care management admission

  • Monitor and follow up on Clinical Reviews and Over Approved Days Workque

  • Document communication and receipt of information, from all members of the healthcare team, including payors and post-acute providers as required

  • Be responsible for administrative functions as it relates to faxing and obtaining clinical documentation for approved bed day hospitalization requirements

  • Assist in determining appropriate coverage including hospitalization, DME, out-patient medications and obtaining authorizations as needed

  • Maintain consistent productivity and quality of work in a challenging, fast paced and rapidly changing environment with frequent interruptions

  • Consistently provide superior customer service that meets or exceeds the expectations of patients, visitors, physicians and PH&S staff, including during periods of high patient volumes or stressful situations

  • Perform independently while multitasking, problem solving, and exercising good time management skills in a fast-paced environment

  • Maintain knowledge of numerous complex compliance requirements and insurance plans, which change frequently

Qualifications:

Required qualifications for this position include:

  • H.S. Diploma or GED

  • 3 years hospital, clinical setting or healthcare related field

  • Must maintain up-to-date knowledge and competency with numerous federal, state and other regulatory body compliance regulations and third party insurance plans, including: Medicare Secondary Payer, EMTALA, and ABN

  • Demonstrated knowledge of HIPAA rules and regulations

  • Demonstrated knowledge of CPT and ICD10 coding and medical terminology

  • Knowledge of or ability to learn InterQual Guidelines application, Word, Excel, EPIC

  • Appropriate escalation of issues and problems as determined by department protocols. Collaborates with clinical staff to enter notes related to authorization status and requested admissions in EPIC

  • Assists ED Hospital Unit Clerk [HUC] in the dispatch of repatriated transfer and provides insurance authorization information when necessary

  • Ability to establish priorities, organize work, be detail oriented and follow through, particularly due to the financial impact if duties are not performed in a timely and accurate manner

  • Ability to identify and solve complex problems

  • Ability to perform multiple tasks simultaneously and work effectively with interruptions

  • Above average verbal and written communication skills: able to read, write legibly and speak fluently using the English language

  • Demonstrated service excellence with patients, families, sponsors, caregivers and team members

  • A track record in organizing and planning with demonstrated ability to effectively manage time and achieve results in a fast paced environment

  • Demonstrates knowledge of and utilizes electronic and automated work tools (e.g., online access tools to payers, work drivers)

  • Basic knowledge of insurance and managed care payers

  • Collaborating with Manage Care contracting on obtaining, Letter of Agreements, eligibility and benefits as it relates to patients services for the organization

  • Demonstrate compliance with all established policies and procedures as they apply to coordination of patient transfer or discharge

  • Develops a high degree of familiarity with client service area geography and medical facilities

  • Demonstrate competency by placing a high priority on service to everyone encountered

  • Anticipate and takes personal responsibility for customer satisfaction and service excellence

  • Consistently goes out of the way to listen, understand, and support the needs of others in a sensitive manner

  • Listens with sensitivity and openness

  • Actively seek constructive feedback and remains open and receptive to it

  • Anticipate the information needs of others

  • Communicate effectively in all interactions

  • Demonstrate competency by maintaining positive, constructive interpersonal relationships, and by understanding and practicing the principles of effective teamwork

  • Work effectively with team members across functional and geographic regions

  • Take responsibility to support team members in meeting project milestones and objectives

  • Display personal behavior that has a positive impact for the team

  • Protect confidential/private information related to patients/guarantors, members, employees, and others

  • Perform challenging tasks efficiently and effectively

  • Anticipate problems and takes corrective action prior to completing the task

  • Set challenging objectives and works against self-defined standards of excellence to continually improve personal performance

  • Show strong attention to detail and excellent analytical skills

  • Exhibit quality focus and active involvement in improvement of work processes

  • Employ learned methods for achieving improved outcomes

  • Exhibit achievement and learning orientation by maintaining a broad outlook, demonstrating personal responsibility for keeping up with current information, expanding knowledge and skill, and ensuring contribution to organizational success

  • Display ability to work in a fast paced environment and participate constructively in change processes

  • Complete annual mandatory education review and competency program

  • Demonstrate performance by adhering to established policies and procedure regarding attendance and punctuality

  • Demonstrate competency by knowing and applying the principles of an inclusive work environment

  • Consistently demonstrates and incorporates principles of safety and infection control into daily activities as outlined in Environment of Care, Infection Control, and Exposure Control manuals and department safety policies/procedures

  • Consistently uses personal protective equipment as required and takes appropriate precautions whenever there is potential for contact with blood, body fluids, chemicals and/or other hazardous materials

  • Maintain knowledge of work-appropriate aspects of environment of care programs complies with policies and reports unsafe conditions

  • Successfully complete Environment of Care Health Stream modules in the required time frames and participates in fire drills and emergency exercises

  • If required, label, transport and store hazardous waste as described in annual training

Preferred qualifications for this position include:

  • Coursework/Training in some college level course work

  • Coursework/Training in Medical Terminology or Medical Assistant

  • 1 year demonstrated outstanding customer service experience

  • 1 year clerical and computer experience

  • Knowledge of insurance billing and managed care

About the hospital you will serve.

Anchored by five award-winning comprehensive medical centers, Providence provides a full spectrum of care that includes a range of specialties, signature services, outpatient and home care and the well-regarded Providence Medical Institute, a group of physicians and primary and urgent care clinics throughout the greater San Fernando Valley and South Bay. Providence is focused on providing the communities it serves with preventive care, education and leading-edge diagnostics and treatment. The organization includes numerous outreach programs. Hospice and home care and even our own Providence High School, a Blue Ribbon college-preparatory campus.

We offer a full comprehensive range of benefits - see our website for details

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Part-time

Shift: Day

Job Category: Administrative (Non-Clinical)

Location: California-Torrance

Req ID: 243161

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