Payroll Title:
BLANK AST 3 PD Department:
PHSO - CLINICAL OPERATIONS Hiring Pay Scale
$30.06 / Hour Worksite:
Greenwich Drive Appointment Type:
Per Diem Appointment Percent:
20% Union:
CX Contract Total Openings:
1 Work Schedule:
Days, 8 Hour Shifts

#128480 UM Referral Coordinator - Per Diem - Hybrid
Extended Deadline: Mon 4/22/2024
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UC San Diego values equity, diversity, and inclusion. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.

Once fully trained, this position may work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive and remotely.

Holiday and weekend availability is required.

DESCRIPTION

Under the direction of the Assistant Director of Utilization Management, the UM Coordinator works as a team member of the UM Department. They process various types of authorizations such as inpatient admission, observation, outpatient procedures, imaging, DME, home health, PT/OT/ST, genetic testing, drugs, psychological services, chiropractic, acupuncture services, etc., in collaboration with RN/LVN Case Managers. The Coordinator verifies eligibility, confirms benefits and DOFR, and processes requests according to established UM guidelines. They handle a large volume of authorizations electronically and via facsimile, compose and respond to emails, and manage the telephone queue for both providers and members. The UM Coordinator should possess a solid understanding and experience of UM processes, including Medicare, Commercial, and Medi-Cal programs, benefits, and policies. They also address retro UM authorizations related to claims resolution. Additionally, the UM Coordinator assists members in navigating the complex health system, facilitating care redirection, appointment scheduling, resource coordination, and resolution of any barriers related to authorization or access to care. Other related duties may be assigned.

MINIMUM QUALIFICATIONS

• Three (3) years of recent experience working in an HMO, IPA, and MSO payer environment.
• Experience processing prior authorizations for Commercial, Medi-Cal, or Medicare membership.
• Experience and thorough understanding of DOFR as it applies to authorizations and UM delegation.
• Strong knowledge of CPT/ ICD codes, minimum health plan benefits, Appeals & Grievances, retro auth processing for outpatient and inpatient, and letter templates.
• Experience with claims/EOB from a payer perspective with the ability to research EOBs.
• Experience with appeals and grievances and processing approval and denial letters.
• Excellent communication skills both verbally and in writing. Excellent customer service skills handling provider calls.
• Skilled in MS Office (Excel, PowerPoint, Outlook, Word, RightFax, etc.). Must possess strong technical and analytical skills.
• Demonstrated ability to coordinate and research the review of difficult, complex Utilization Management issues.

PREFERRED QUALIFICATIONS

• Experience within high volume HMO or IPA/MSO utilization management /prior authorization department is highly preferred.
• Good knowledge of HMO benefits/policies for authorization; Understanding of Division of Financial Responsibility (DOFR).
• Strong understanding of Medicare, Commercial health plan benefits.
• Experience with processing retro claims/UM authorizations/appeals/grievances.
• Electronic Medical Record/ Epic experience.
• Experience working on a multidisciplinary team.

SPECIAL CONDITIONS

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.
• Holiday and weekend availability required.
• Employee required to have consistent high-speed internet and appropriate workstation when working remotely.

Pay Transparency Act

Annual Full Pay Range: $62,765 - $62,765 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: $30.06 - $30.06

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).

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If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community .

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

For the University of California's Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20
For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.