Coordinator-UtilizationMgt/Rvw

Loma Linda University Health; Loma Linda (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Loma Linda University Health is seeking a Coordinator for Utilization Management/Review to support admission and transfer processes across LLUMC, Surgical Hospital, East Campus Hospital, and Children's Hospital.

In this role, you will coordinate medical and surgical admissions, process intake calls, and collaborate with payers, clinics, and the Patient Business Office to secure authorizations while ensuring timely, compliant patient placement in a fast-paced academic medical center.

Qualifications

• Understanding HIPAA and patient rights.
• Knowledge of healthcare insurance processes and payer interactions.
• Ability to read, write, and communicate in English; Spanish preferred.
• Able to work with minimal supervision and meet deadlines.

Responsibilities

• Coordinate and monitor admissions and transfers for LLUMC and affiliated hospitals.
• Process intake calls for ED to ED transfers and interfacility transfers.
• Interface with payers, clinics, and PBO for eligibility and authorizations.
• Maintain and update transfer center work queues and support daily operations.

Skills

HIPAA knowledge

Medical terminology

English communication

Spanish preferred

Attention to detail

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.