Coordinator-UtilizationMgt/Rvw

Loma Linda University Health; Loma Linda (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

Loma Linda University Health in California is seeking a Coordinator-Utilization Management/Review to support the daily operations of Patient Placement Services across LLUMC, Surgical Hospital, East Campus Hospital and Children’s Hospital. You will coordinate admissions and transfers, monitor transfer center queues and handle intake calls.

In this role you will collect demographic, financial and clinical data, interface with payers and clinics for authorization, work with the Clinical Admission

Qualifications

• High school diploma or GED required.
• Minimum of three years of experience in a medical group, managed care organization, utilization management, hospital admitting or medical nursing unit.
• Basic knowledge of HIPAA, health insurance and patient rights.
• Strong communication and the ability to work with minimal supervision.

Responsibilities

• Coordinate and monitor admissions and transfers to LLUMC and affiliated hospitals.
• Process intake calls for ED to ED transfers and interfacility transfers.
• Interface with payers and PBO for eligibility and authorization.
• Collaborate with the Clinical Admission Nurse and problem-solve under pressure in a fast-paced academic medical center.

Skills

HIPAA knowledge

English proficiency

Spanish preferred

Education

High school diploma or GED

Job description

Job Summary

The Coordinator-Utilization Management/Review functions effectively in a tertiary care academic medical center with level one trauma designation, ST-Elevation Myocardial Infarction (STEMI) receiving center designation and comprehensive stroke center accreditation in an academic teaching medical center. Works collaboratively with the Clinical Admission Nurse in a fast-paced environment and is responsible for the support of the daily operations of Patient Placement Services related to the admission and transfer of patients into Loma Linda University Health hospitals (Loma Linda University Medical Center (LLUMC), Surgical Hospital, East Campus Hospital, Loma Linda University Children's Hospital) from multiple portals of entry. Coordinates and monitors medical and surgical planned admissions, monitors and updates the Patient Placement and Transfer Center Work Queues. Processes intake calls for ED to ED transfers, interfacility transfers, urgent admissions, including coordinating and connecting transferring physician to receiving physician. Collects pertinent demographic, financial and clinical data on all intake calls. Interfaces with payers and clinics regarding authorization for admission, collaborates with Patient Business Office (PBO) for identification of payer sources/eligibility/indigent programs. Demonstrates ability to make solid decisions and work with minimal supervision. Performs other duties as needed.

Education and Experience

High school diploma or GED required. Minimum of three years of experience with a medical group, managed care organization, utilization management, hospital admitting or medical nursing unit required.

Knowledge and Skills

Basic knowledge of medical terminology, Health Insurance Portability and Accountability Act (HIPAA) and patient rights required. Working knowledge of healthcare insurances and health plans required. Able to read; write legibly; speak in English (and Spanish preferred) and relate and communicate positively, effectively and professionally with others; think critically; work with minimal supervision and meet firm deadlines; use computer, printer and software programs necessary to the position; operate and troubleshoot equipment required for the position; be assertive and consistent in following policies; work calmly and respond courteously when under pressure; accept and follow directions; perform basic math functions; manage multiple assignments effectively; organize and prioritize workload; collaborate with registered nurse to problem solve; recall information with accuracy; pay close attention to detail; function within scope of practice; distinguish colors, hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the work place; see adequately to read computer screens, medical records and written documents necessary to position.

Licensures and Certifications

Nationally recognized certification in Utilization Management, Utilization Review, Hospital Utilization Review or Managed Care preferred.

About Us

Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork and wholeness.

About The Team

Loma Linda University Health is a Seventh-day Adventist, faith and values based Christian institution. Candidates must understand and embrace the mission, purpose, and identity of Loma Linda and its affiliated entities.

Equal Opportunity Employer

We are an equal opportunity employer committed to the principles of diversity. We provide equal opportunities in all aspects of the employment process to every individual, regardless of gender, race, color, age, national origin, ancestry, physical or mental disability, marital or veteran status, genetic information or any other characteristic protected by law. In addition, we will provide reasonable accommodations for otherwise qualified individuals requesting an accommodation due to a disability. If you need accommodation assistance with accessing our job listings or completing an application, or during any other phase of employment with us, please contact Human Resources Management at [phone].

Loma Linda University Children's Hospital is a religiously-qualified Equal Opportunity Employer under Title VII of Civil Rights Act of 1964. No question on this application is asked for the purpose of unlawfully limiting or excluding any applicant’s consideration for employment because of race, color, religion, gender, age, national origin, disability, genetic information, or any other status protected by applicable law. If you need a reasonable accommodation in the hiring process, please notify Human Resource Management.

We appreciate your interest in Loma Linda and wish you success in your job search!