Case Management Coordinator - Ambulatory Case Management

Are you ready to bring your clinical competencies to a world-class Medical Group known for the very highest clinical standards? Do you have a passion for the highest quality and patient satisfaction? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.

The Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians provide excellent care to all their patients, who benefit from convenient access to primary and specialty care physicians and seamless coordination of care between them. As a part of Cedars-Sinai, our physicians and staff are partners in quality health care from a medical center that is consistently recognized as one of the finest hospitals in the country. For the 8th consecutive year, we have been named one of the top 20 Physician Groups in Southern California by Integrated Healthcare Associates (IHA).

Why work here?

Beyond outstanding benefits, competitive salaries and health and dental insurance we take pride in hiring the best, most passionate employees. Our talented staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.

What will you be doing in this role?

The Case Management Coordinator, Utilization Management, provides support to the utilization review process. The coordinator works collaboratively with all team members of Utilization Management, Patient and Provider Services, Claims Department and other Care Coordination Department staff. In addition, the coordinator assists in identifying, tracking and coordinating services for patients when needed. The position requires strong written and communication skills and the ability to interact with Medical Directors, Providers, CSMNS members, Medical Group and IPA's to ensure the delivery of high quality, cost effective healthcare and compliant with all state and federal regulations and guidelines.

Primary Duties and Responsibilities

• Enters data and processes referral authorization requests, to include appropriate coding and quantities.
• Answers incoming calls from Providers, IPAs, Medical Groups and other internal and external calls and assists on the queues as needed
• Monitors the Fax Inbox and appropriately distributes incoming faxes. Ensures that internal compliance security measures are met
• Verifies member eligibility before processing authorizations
• Contacts facilities identified by the UM Nurses/Manager/Director/Medical Director to research any issues (i.e. contract, discharges, services provided).
• Identifies non-contracted providers and requests Letter-of-Agreements when requested.
• Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors, or Management
• Processes Extensions and Denial Letters, when needed
• Prepares Utilization Review Reports as necessary
• Assists the Case/Care Managers in coordinating and arranging services for members
• Provides assistance to the Claims Department, when requested
• Documents all patient specific information in appropriate information systems.
• Assists in verifying health plan benefits and coordinating ambulatory services.

Job qualifications

Education

• High School Diloma/GED required 

Work Experience

• 1 year Healthcare experience, a general knowledge of medical terminology and experience with community resources and social supports required
• 1 year Previous utilization management or managed care experience; word processing spreadsheet skills also preferred preferred