Utilization Management Lead - Referrals & Compliance

hdmg; Lancaster (CA); Vor Ort; USD 37.000 - 51.000; Vollzeit

Zusammenfassung

hdmg seeks a UM Lead to oversee day-to-day activities in the Referral Management Department. You will assist Medical Director and Physician Reviewers by gathering medical records and documentation to support referral determinations.

Responsibilities include processing pre-service referrals, verifying eligibility and benefits, coordinating authorizations, and training staff under UM Manager guidance. Strong communication and multitasking are essential.

Qualifikationen

• High school graduate or equivalency.
• Ability to communicate effectively with patients, family members, vendors and providers.
• Working knowledge of Word, Excel, PowerPoint, EZ-Cap, Medic, and Report Writer.
• Must have excellent communication skills both verbally and written.
• Ability to handle a multitude of assignments, meeting all deadlines.
• Knowledge of correct punctuation, grammar and spelling.
• Ability to deal responsibly with confidential matters.
• Ability to prioritize work to meet daily deadlines.
• Ability to work in a multi-task, high productive environment.
• Ability to supervise staff with varying job responsibilities and assignments.
• Ability to analyze routine statistical reports and communicate outcomes to supervisor/leadership.
• Knowledge of inventory control and supply ordering.
• Understanding of current state and federal regulations pertaining to managed care delivery system.

Aufgaben

• Coordinates accurate and timely processing of pre-service referrals by gathering necessary medical records.
• Ensures accurate eligibility and benefit verification.
• Facilitates timely communication of authorizations to providers, members, and health plans.
• Communicates with health plans when issues with coverage or responsibility arise.
• Provide training and education to other UM Coordinators, Nurses, and Physician Reviewers.

Kenntnisse

Effective communication

Multitasking

Time management

Staff supervision

Ausbildung

High school diploma or equivalent

Tools

Word

Excel

PowerPoint

EZ-Cap

Medic

Report Writer

Jobbeschreibung

hdmg seeks a UM Lead to oversee day-to-day activities in the Referral Management Department. You will assist Medical Director and Physician Reviewers by gathering medical records and documentation to support referral determinations.

Responsibilities include processing pre-service referrals, verifying eligibility and benefits, coordinating authorizations, and training staff under UM Manager guidance. Strong communication and multitasking are essential.