SUMMARY DESCRIPTION:

The Utilization Support Coordinator will be assigned in the areas of Utilization Management ensuring all services for which prior authorizations are built from incoming provider calls or faxes.

ESSENTIAL FUNCTIONS:

• Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed.
• Answers phone queues and processes faxes within established standards.
• Updates provider information on authorizations for claims processing
• Data enters authorizations cases in the documentation systems.
• Reviews requests for eligibility and benefits.
• Reviews requests for required documentation and requests required documentation as needed.
• Effectively communicates to management and internal departments timely.
• Receives and responds to all incoming calls from PCPs, specialists, other providers, electronic notification applications, members, authorized representatives, etc. regarding
• inpatients, surgeries, and outpatient services including DME, Home Health Care and other services requiring a pre-authorization.
• Performs other duties, projects and actions as assigned.
• Interacts with Medical Directors, Pharmacists, Behavioral Health Clinicians, Other Care Management Team Members.
• Performs other duties, projects and actions as assigned.

Required Qualifications

• High school diploma or equivalent experience.
• 2+ years of relevant professional experience, UM experience a plus
• Demonstrate effective verbal and written communication skills.
• Demonstrate excellent organizational skills.
• Demonstrate analytic skills when problem solving.
• Proficient in MS Office Applications and ability to learn department and job specific software systems.
• Demonstrate high attention to detail and a high degree of accuracy.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.