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Utilization Management Coordinator

Utilization Management Coordinator

Job Title: Utilization Management Coordinator
Job Category: Administrative/Clerical
Division: Torrance Health IPA
Position Type: Full time
Shift Length: TBD
Location: Torrance, CA

Resumes go to: Barbara.Latam@tmmc.com

The Utilization Management Coordinator is responsible for completing the majority of the clerical tasks in the Utilization Management department.

Primary Duties and Responsibilities:

  • Review and authorize referrals according to the clinical guidelines for services within their scope of approval
  • Support the UM nurses in managing the referrals as directed by the nurse
  • Review and verify member eligibility using available tools to obtain the most accurate information
  • Receive, manage, and respond in a timely manner to phone calls from providers and members
  • Receive, research, and obtain resolution to UM related inquiries from members
  • Demonstrate professional telephone etiquette and customer service skills when making outbound calls to members within the required time line to inform them of the UM decisions
  • Follow necessary steps and document appropriately to process and issue Deferral letters
  • Contact physicians’ offices to obtain medical records necessary to perform utilization review
  • Issue denial letters, review with nurses for accuracy, print, and prepare to mail. Responsible to meet the required turn-around time
  • Meets regulatory turn-around time and departmental productivity goals when processing referrals

Knowledge, Skills & Experience Required:

  • High School Diploma/GED required
  • Excellent clerical, written and oral communication skills, typing, and data entry skills; excellent telephone and customer service skills; must be organized and a self-starter
  • Must be able to work independently with minimal supervision
  • Must be a problem solver, understand medical terminology, some knowledge of Managed Health Care is highly preferred
  • Must be reliable and possess the ability to stay on-task during work hours

Qualified candidates should submit their resume to Barbara.Latam@tmmc.com for consideration.