Utilization Management Coordinator

Description

Title: Utilization Management Coordinator



Location: Fountain Valley



Department: Utilization Management



Status: Full-time



Shift: Day / Tuesday - Saturday



Pay Range*: $22.22/hour - $32.21/hour

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.



Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability.Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.



Position Summary



The Inpatient Utilization Management Coordinator is responsible for supporting the Inpatient Nurse Case Managers in the discharge needs of our hospitalized members. They coordinate with various institutions, vendors, home health agencies and personnel to process member's requests and perform administrative duties under the Inpatient Nurse Case Manager’s direction. They also submit logs, documents, write reports, verify referral information, and monitor post discharge follow-up care. Utilization Management Coordinators must have excellent communication, and organizational skills , especially in interacting with people in determining immediate solutions.

Essential Functions and Responsibilities of the Job



1. Assists with the completion of the admission/discharge log that is sent to the primary health plan



2. Collaborates with nurse case managers regarding transitional care planning and post discharge follow-up



3. Submits referrals to Complex Case Management if member meets criteria



4. Assists member with the scheduling of medical and diagnostic appointments with the clinics as needed



5. Refines essential intervention skills including active listening, therapeutic communication and the ability to interact with a broad variety of people



6. Conducts follow-up phone calls to members to document compliance with authorized services, like Home Health and DME delivery. Reports variance of discharge plan to the nurse case manager.



7. Reinforces discharge education provided to the member/family/caregiver and identifies potential problems that may lead to an ED visit or readmission



8. Documents clearly and concisely in the case management electronic record, Compass Rose.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more... Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Qualifications

Experience

• Minimum 2-3 years of medical management experience especially in Case Management a plus
• Knowledge of clinical and medical terminology a plus
• Experience in EPIC/Tapestry a plus.

Education

• High School Diploma or GED equivalent
• Associates Degree or certification in a healthcare related field a plus