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UnitedHealth Group

Utilization Management Coordinator, AppleCare Medical - La Palma, CA

UnitedHealth Group - La Palma, CA

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AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board - certified private - practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities. As a part of our continued growth, we are searching a newUtilization Management Coordinatorto join our team.Primary Responsibilities: Manage administrative intake of members or the admission / discharge information post notification

Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and / or providers

Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles

Receive care coordination notification cases for non - clinical assessment / intervention and provide appropriate triage

Review requests for adverse determination, approval notification and processing notification requirements

Assist the clinical staff with setting up documents / triage cases for Clinical Coverage Review

Handle resolution / inquiries from members and / or providers that may include: o Benefit and Eligibility informationo Billing and Payment issueso Customer material requestso Physician assignmentso Authorization for treatmento Explanation of Benefits (EOB)o Verifying appropriate ICD - 10 and CPT coding usage Qualifications:

Required Qualifications: 1 years ofexperience in managed care environment or 3 years in a medical office or clinic setting as a medical assistant or a referral coordinator

HS Diploma or GED

2 years of customer service experience analyzing and solving customer problems

Must be able to create, edit, save and send documents utilizing Microsoft Word and Excel

Must be able to navigate a PC to open applications, send emails, and conduct data entry

Preferred Qualifications: Experience working within the Healthcare Industry

Experience working with Healthcare Insurance

Experience working in a Hospital, Physician's Office, or Medical Clinical setting

Professional experience in a clerical or administrative support related role

Working Knowledge of Medical Terminology to communicate with members and providers

Experience working with ICD - 10 and CPT codes

Experience working with Medicare and / or Medicaid Services

Experience working in a call center environment AppleCare Medical Management Group. The multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities. What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. AppleCare Medicalis a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Utilization Management, UM,Utilization Review, UR, Managed care, La Palma, CA, California

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8 days 1 hour ago

UnitedHealth Group

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Utilization Management Coordinator, AppleCare Medical - La Palma, CA UnitedHealth Group - La Palma, CA, United States

   

Location: La Palma, CA

Company Profile:
About UnitedHealth Group UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone. We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term