The UM Referral Coordinator is responsible for providing technical, administrative and clerical support for the Utilization Management department, working closely with the Nurse Case Managers and Physician Reviewers. This position creates and assists with the preparation of referral requests. As part of the preparation process will verify eligibility, benefits, request any needed clinical notes and accurately complete or forward referral to higher level of review. Ensures that all referral policies and procedures are followed as required to meet all contractual, regulatory and federal requirements.
Essential Job Outcomes
Must be detail oriented and have excellent organizational skills
Must be able to work independently, but also in a team structure
Accurate data entry and documentation into all appropriate systems
Ability to handle difficult calls and maintain professional conduct
Attends all staff meetings and in-services
Maintains the principles of member confidentiality in every interaction
Willingness to be flexible with job responsibilities
Proficiency with EPIC, Aerial Care and MHC
Assigns and moves cases to next level of review when appropriate
Validates that authorization requests are complete and requests additional data when necessary.
Knowledge of ICD-10 and medical terminology
Confirms member eligibility and benefits.
Able to serve as resource to other departments, i.e. claims, network, member services
Demonstrates the ability to explain managed care principles, i.e. contracted, non-contracted, full risk, shared risk, in-network, out-of-network
2 years of experience in healthcare setting; medical office, hospital; health plan
Excellent computer skills
Knowledge of medical terminology
Customer service and interaction with patients/members
Excellent verbal and written communication skills
Keyboard speed and accuracy, 40-50 wpm
High School Diploma or GED equivalent
Medical Assistant Certificate preferred
Internal Number: SEA000096
About Seaside Health Plan
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.