Remote Utilization Management (UM) Coordinator (Long-Term Temporary w/ Medical Benefits)

Job Number: 6634
Workplace Type: Fully Remote
Position Title:Utilization Management Coordinator
External Description:
Overview of the Role:
Alignment Health is seeking a Remote Utilization Management (UM) UM Coordinator for a long-term temporary engagement (with Medical Benefits) to assist and support the clinical team, UM nurse, and medical director with administrative tasks related to processing Utilization Management's clinical referrals.
Note: Since Alignment Health is continuing to expand, there is a possibility the engagement could possibly extend and / or convert depending on budget, business need, and individual performance.
Schedule: Monday - Friday

• Pacific Time: 8am - 5pm
• Mountain Time: 9am - 6pm
• Central Time: 10am - 7pm
• Eastern Time: 11am - 8pm

Responsibilities:

• Monitor fax folders
• Verify eligibility and / or benefit coverage for requested services.
• Enter pre-service requests / authorizations in system using ICD 10 and CPT coding.
• Verify all necessary documentation has been submitted for pre-service request.
• Contact and request medical records, orders, and / or necessary documentation from requesting provider in order to process related pre-service requests / authorizations when necessary.
• Accurately documents referral process and any pertinent determination factors within the referral system.
• Process pre-service request for medical services such as durable medical equipment (DME), office visits and radiology using approval criteria.
• Assist with mailing or faxing correspondence to PCP's, Specialists, related to requests / authorizations as needed.
• Contact members and maintain documentation of call for Expedited requests.
• Comply with tasks assigned by nurse and, as appropriate, documents accordingly.
• Answer queue calls relating to UM review and pre-service status.
• Recognize work-related problems and contributes to solutions.
• Meet specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs).
• Maintain confidentiality of information between and among health care professionals.

Required Skills and Experience:

1. Minimum 1-year experience in a medical setting working with IPAs, entering referrals / prior authorizations preferred.
2. Knowledge of ICD10, CPT codes, Managed Care Plans, medical terminology (certificate preferred) and referral system (Access Express / Portal / N-coder) required.
3. High School Diploma or General Education Degree (GED) and / or training: or equivalent combination of education and experience required.
4. Knowledge of Medicare Managed Care Plans
5. Computer proficient
6. Able to type minimum 50 words per minute (WPM)
7. Experience with Microsoft Word, Excel, and Outlook
8. Experience with the application of UM criteria (CMS National and Local Coverage Determinations, etc.)
9. Bilingual English / Spanish preferred
10. Positive, team player

PAY RANGE: $40,600 - $60,900 annually.
City: Remote-US
State: California
Location City: Remote-US
Location State: California
Community / Marketing Title:Remote Utilization Management (UM) Coordinator (Long-Term Temporary w/ Medical Benefits)
Company Profile:
By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! 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, 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].