1+ months

Referral Authorization Coordinator - Vista, CA - 900756

Vista, CA 92084
  • Job Code
    900756
  • Jobs Rated
    136th

For those who want to invent the future of health care, here's your opportunity! We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doingyour lifes best work.(sm)

""

""

For over 18 years, PCAMGhas been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. PCAMGis well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.

""

The NAMM/PCAMGprovider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.

""

North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations.

""

""

As a part of our continued growth, we are searching for a new Utilization Management Technician to join our team.
"

""

The Utilization Management Technician screens all the incoming electronic submissions for referrals from our Providers. These can include requests for authorization of services such as: referrals to Specialists, inpatient admission, pre-certifications for surgeries, DME, or home health referrals etc. They are responsible for verifying member eligibility, benefits verification and helping to ensure the services we are providing are in-network.

""

""

Primary Responsibilities:

""
    ""
  • Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
  • ""
  • Working with hospitals and the clinical team, including managing incoming calls, managing requests for services from providers/members, providing information on available network services
  • ""
  • Administrative intake of members or managing the admission/discharge information post-notification
  • ""
  • Verifies eligibility and benefits for each referral and accurately documents into computer system
  • ""
  • Processes electronic referrals in Queues and generates authorizations
  • ""
  • Inputs paper referrals into computer system and generates authorizations
  • ""
  • Provides referral and authorization to external providers
  • ""
  • Accurately uses database for daily documentation of information required for denial letters for patients whose benefits do not cover requested services
  • ""
  • Seeks to obtain complete clinical information from providers as required for decision making
  • ""
  • Maintains Health Plan turnaround time requirements and standards for referrals/authorizations
  • ""
  • Interfaces effectively with contracted physicians and medical staff to provide referral process training as needed
  • ""
  • Transfers members as appropriate to clinical staff and channels referrals to contracted providers
  • "
""

""

Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

""

""

"

Required Qualifications:

""
    ""
  • High school diploma or GED
  • ""
  • 1+ years of experience working in the Medical Field: i.e. outpatient clinic, urgent care center, skilled nursing facility
  • ""
  • Intermediate computer skills: MS Office- Outlook, Word, Excel & PowerPoint
  • "
""

Preferred Qualifications:

""
    ""
  • Managed Care experience
  • ""
  • Coding experience
  • "
""

""

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to doyour life's best work.(sm)

""

""

North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

""

""

NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.

""

""

The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.

""

""

OptumHealthhelps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
"
"AtOptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.

""

""

""

Diversity creates a healthier atmosphere: 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.

""

""

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

""

""

Job Keywords: Utilization Management Technician, Vista, CA, California

Categories

Jobs Rated Reports for Author

Posted: 2020-12-03 Expires: 2021-03-27

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.

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Referral Authorization Coordinator - Vista, CA - 900756

UnitedHealth Group
Vista, CA 92084

Join us to start saving your Favorite Jobs!

Sign In Create Account
Author
136th2019 - Author
Overall Rating: 136/199
Median Salary: $62,170

Work Environment
Fair
100/220
Stress
High
171/220
Growth
Poor
135/220
Powered ByCareerCast