Utilization Management (UM) Coordinator (Inpatient)

Job Number: 7230

Workplace Type: Fully Remote

Position Title: Utilization Management Coordinator

External Description:

Overview of the Role:

Alignment Health is seeking an organized, detail-oriented and customer service oriented inpatient utilization management (UM) coordinator to join the UM team. As an inpatient UM coordinator, you will assist with managing census and admissions, retrieve medical records, and discharge planning while working with the case management (CM) supervisor, manager, and director of healthcare services.

If you are hungry to learn and grow, want to be part of a growing organization, and make a positive impact in the lives of seniors – we’re looking for you!

Responsibilities:

• Assist team with daily census by entering face sheets for hospitals and skilled nursing facilities (SNF).
• Obtain medical records from hospitals and SNF’s.
• Attach medical records to authorizations.
• Enter referral requests / authorizations in system using ICD 10 and CPT coding.
• Monitor fax folders.
• Complete and document tasks as assigned by nurse.
• Maintain documentation on facilities contacted.
• Assist with maintaining and updating member’s records.
• Assist with mailing or faxing correspondence to facilities, related to, as needed.
• Request medical records from facilities, etc., related to members activities, as needed.
• Attend case management presentations and participates, as appropriate.
• Recognize work-related problems and contributes to solutions.
• Meet specific deadlines (respond to various workloads by assigning task priorities according to department policies, standards and needs).
• Maintain confidentiality of information among health care professionals.

Required Skills and Experience:

• Inpatient concurrent review experience
• Experience with census and admission management
• Experience in discharge planning
• Experience entering referrals and prior authorizations.
• Experience with Medicare Advantage
• Experience with hospital and / or facilities backend admissions
• Medical assistant experience preferred
• High school diploma or general education degree (GED); with one to three months related experience and/or training; or equivalent combination of education and experience.
• Medical Terminology Certificate preferred.
• Knowledge of medical terminology
• Knowledge of ICD10 and CPT codes
• Knowledge of Medicare, HMO, MMO, managed care plans
• Knowledge working in Access Express / Portal, Epic preferred.
• Computer proficient
• Proficient in Microsoft Office (Outlook, Excel, Word)
• Able to type minimum 55 words-per-minute (WPM).
• Organized and detail oriented.
• File systematically.
• Good interpersonal skills.
• Strong written, verbal, and telephonic communication skills
• Able to read, write, and speak English fluently.
• Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Able to write routine reports and correspondence.  Communicate effectively using good customer relations skills.
• Mathematical Skills: Able to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s.  Able to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Able to deal with problems involving a few concrete variables in standardized situations.
• Able to reason and carry out instructions.

PAY RANGE: $41,500 - $52,000 annually

City: Remote - CA

State: California

Location City: Remote - CA

Location State: California

Community / Marketing Title: Utilization Management (UM) Coordinator (Inpatient)

Company Profile:

Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].