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Utilization Management Coordinator - La Palma, CA

UnitedHealth Group


Location:
PALMA, CA
Date:
08/22/2017
2017-08-222017-09-20
Job Code:
1742145
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Job Details


Utilization Management Coordinator - La Palma, CA(Job Number:711916)
Description

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives. As one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high - quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work.(sm)

 

AppleCare Medical Management Group was incorporated in 2003.  Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board - certified private - practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.


What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

Primary Responsibilities:
  • Manage administrative intake of members or the admission / discharge information post notification
  • Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and / or providers
  • Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
  • Receive care coordination notification cases for non - clinical assessment / intervention and provide appropriate triage
  • Review requests for adverse determination, approval notification and processing notification requirements
  • Assist the clinical staff with setting up documents / triage cases for Clinical Coverage Review
  • Handle resolution / inquiries from members and / or providers that may include:
    o          Benefit and Eligibility information
    o          Billing and Payment issues
    o          Customer material requests
    o          Physician assignments
    o          Authorization for treatment
    o          Explanation of Benefits (EOB)
    o          Verifying appropriate ICD - 10 and CPT coding usage

Job Clinical Admin & Processing
Primary Location US-CA-LA PALMA
Other Location US-CA-Anaheim, US-CA-Long Beach
Organization AppleCare
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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