Referral Coordinator, UM

Description

Title: Referral Coordinator, UM

Location: Fountain Valley

Department: Utilization Management

Status: Full-time

Shift: Days

Pay Range*: $20.75/hour - $29.47/hour.

At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare. 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 UM Referral Coordinator is r e sponsible f or providing technical, administrative, and clerical support for the Utilization Management department, working closely with the Nurse Case Managers and Physician Reviewers. This position creates and assists with the preparation of referral requests. As part of the preparation process will verify eligibility, benefits, request any needed clinical notes and accurately complete or forward referral to higher level of review. Ensures that all referral policies and procedures are followed as required to meet all contractual, regulatory and federal requirements.

Essential Functions and Responsibilities of the Job

1. Research and process incoming referral requests received via fax or Provider Portal generated

2. Check Health Plan eligibility and benefits as needed

3. Gather clinical notes and Health Plan criteria as needed

4. Scan and attach faxed clinical information to referral in system

5. Demonstrate good problem-solving skills

6. Provide a high standard of customer service for Health Plan members, Providers and clinic staff

7. Demonstrates professional and courteous communication skills.

8. Ability to follow company policies, procedures and directives

9. Ability to interact in a positive and constructive manner

10. Ability to prioritize, multitask with attention to detail and timeliness for task completion.

11. Perform any additional duties that may not be inclusive in job description as requested by Management team that is within the scope of knowledge or ability of the Referral Coordinator.

*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 moreCheck out our MemorialCare Benefits for more information about our Benefits and Rewards.

Qualifications

Experience

• 2 years of experience in healthcare setting; medical office, hospital; health plan preferred
• Excellent computer skills
• Knowledge of medical terminology
• Customer service and interaction with patients/members
• Excellent verbal and written communication skills
• Keyboard speed and accuracy, 40-50 wpm

Education

• High School Diploma or GED equivalent
• Medical Assistant Certificate preferred