Cedars-Sinai Case Management Coordinator in Los Angeles, California
Case Management Coordinator Requisition # M12131
The Case Management Coordinator, Utilization Management, provides support to the utilization review process. The coordinator works collaboratively with all team members of Utilization Management, Patient and Provider Services, Claims Department and other Care Coordination Department staff. In addition, the coordinator assists in identifying, tracking and coordinating services for patients when needed. The position requires strong written and communication skills and the ability to interact with Medical Directors, Providers, CSMNS members, Medical Group and IPA’s to ensure the delivery of high quality, cost effective healthcare and compliant with all state and federal regulations and guidelines.
DUTIES & RESPONSIBILITIES:
- Enters data and processes referral authorization requests, to include appropriate coding and quantities
- Answers incoming calls from Providers, IPAs, Medical Groups and other internal and external calls and assists on the queues as needed
- Monitors the Fax Inbox and appropriately distributes incoming faxes. Ensures that internal compliance security measures are met
- Verifies member eligibility before processing authorizations
- Identifies non-contracted providers and requests Letter-of-Agreements when requested
- Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors, or Management
- Processes Extensions and Denial Letters, when needed.
- Monitors the Turn Around Timeframes
- Contacts facilities identified by the UM Nurses/Manager/Director/Medical Director to research any issues (i.e. contract, discharges, services provided).
- Prepare Utilization Review Reports as necessary.
- Assists the Case/Care Managers in coordinating and arranging services for members.
- Assists the Claims Department, when requested
- Responds to variations in daily workload by evaluating task priorities according to department policies and standards.
- Maintains confidentiality of information between and among health care professionals.
- Other duties as assigned.
ESSENTIAL JOB DUTIES:
• Review hospital admissions information and enter/update inpatient, SNF, home health and DME referrals as necessary.
• Print and distribute daily census.
• Seek and accept referrals for target patient populations, i.e. fragile seniors, catastrophic and transplant cases, frequent utilizer of ER and inpatient services, and patients diagnosed with specific diseases (cancer, asthma, COPD, AIDS, etc.).
• Act as a liaison, gather information and track all patients referred to the ACM/disease state management programs.
• Assist in coordinating care for specific high risk/high cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
• Document all patient specific information in appropriate information systems.
• Assist in verifying health plan benefits and coordinating ambulatory services.
• Assume other duties as delegated.
Education Certifications/Licensure Experience Physical Abilities MINIMUM JOB REQUIREMENTS/COMPETENCIES: High School diploma, at least one year of healthcare experience, a general knowledge of medical terminology and experience with community resources and social supports. Preferred qualifications include previous utilization management or managed care experience; word processing spreadsheet skills also preferred.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Working Title: Case Management Coordinator
- Business Entity: MDN - Medical Delivery Network
- Cost Center # - Cost Center Name: 0875150 - MNS UR/CM
- City: Los Angeles
- Job Category: Allied Health/Clinical
- Job Specialty: Other Allied Health
- Position Type: Regular-F/T
- Shift Length: 8hr
- Hours: 8:00am - 5:00pm
- Days: Monday - Friday
- Shift Type: Day
- Weekends: None
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.