CM Care Coordinator

JOB TITLE: UM Coordinator FLSA STATUS: Non-Exempt

DEPARTMENT: Utilization Management

REPORTS TO: Supervisor, Utilization Management

JOB SUMMARY: This position processes authorizations and ensures that all information is correct before submitting for approval. All authorizations should be entered within a timely manner with complete data, as well as, all the documents that will support medical necessity. The UM Coordinator will need to have strong written/communication skills in order to provide Medical Director, providers, and members necessary information to ensure the delivery of high-quality effective healthcare.

Essential Job Functions

• Open and process UM incoming faxes periodically throughout the business day.
• Answer phones: Providing customer service to calls from providers and/or members.
• Print approvals and modification letters from the database on a daily basis.
• Scan any faxes to existing authorizations in the system.
• Route medical reviewer's cases to appropriate personnel in timely manner on a daily basis.
• Verify duplicate requests and call/notify doctor's office of referral request cancellations.
• Contact and follow up with providers on pending clinical/documents within the turnaround time. (Routine 5 days, Urgent 72 hours).
• Verify and update all missing information (DOS, POS, outpatient or inpatient) before submitting for approval.
• Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
• Maintains regular and consistent attendance.
• Adheres to Compliance Plan and HIPAA regulations.

Marginal Job Functions

• Takes on special projects as needed.
• Performs other duties as assigned.

Behavioral Expectations

• Continuous Learning:
• Attends staff meetings as required.
• Attends appropriate training, seminars and workshops as required
• Customer Focus:
• Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

• Fosters appropriate communication and relations with Supervisor, co-workers and other staff.
• Quality/Process Improvement/Safety
• Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.
• Supports and demonstrates safety throughout all duties performed.
• Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

Education/Experience POSITION REQUIREMENTS:

• High school graduate or equivalent.
• 1 year of experience required
• Must have experience in making outgoing phone calls as well as taking incoming phone inquiries

Skills/Knowledge/Ability

• Proficiency in Microsoft Suite and computer use
• Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to residents and staff.
• Willingness and ability to follow written and verbal direction in English.
• Willingness and ability to maintain appropriate level of confidentiality and privacy.
• Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
• Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.
• Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
• Ability to effectively prioritize items/tasks as required.
• Willingness and ability to take initiative and be a self-starter.
• Willingness and ability to understand and comply with Federal, State, and local regulations.

Licensure/Certificate/Training

• n/a