UM Coordinator

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California 

****This position is work from home within California.

In this role, you will execute all aspects of the referral process and promote the quality and cost effectiveness of medical care through strict adherence to all Utilization Management (UM) Policies and procedures promptly, efficiently and accurately. The UM Coordinator collaborates with clinical team members to evaluate the potential over and under-utilization of specialty services based on clinical protocols.

Essesntial functions include:
- Communicate effectively and interact with the utilization review nurse and health plans daily or as indicated regarding UM and referral authorization issues.
- Data entry via the core admin platform/software
- Process request that are approved, denied or deferred and in accordance with utilization management policy and procedure.
- Responsible for Deferred authorization maintenance, tracking and follow up.
- Responsible for the EIOD process, including log maintenance; and member notifications
- Returns phone calls to members, physicians and health plans and follows up with requests.

Minimum Qualifications:

- 3+ years working in a health care or other related business environment working in authorizations, medical office and/or medical billing services
- High school diploma or GED
- Proficient in Google Workspace/Microsoft Office programs
- Knowledge of PPO/HMOs, IPAs and Managed Care.
- General knowledge of EZCAP

Preferred Qualifications:

- Vocational school graduation in medical front office, or medical billing and coding preferred
- Knowledge of Medicare processing guidelines preferred