Utilization Management (UM) LVN Case Manager

Utilization Management (UM) LVN Case Manager Bakersfield, CA 93311 $30

• $34 an hour
• Full-time $30
• $34 an hour

•

Full-time Location:

In Office On-Site Position The UM Coordinator provides effective communication between

MSO, IPA

providers, and members to coordinate member care. Communication to include accessibility to care, validating contract entities, and ensuring timeliness standards are met. Duties and Responsibilities Process authorization requests per timeliness regulations Validate data entry process for errors Verify member benefits and eligibility upon receipt of treatment authorization request Utilizes authorization matrix, ancillary rosters, DOFR and/or delegation agreements to drive decision-making Coordinates with referral Clinician and/or Medical Director for timely processing Communicate with Medical Directors to facilitate Medical Reviews for non-clinical medical review referrals Outreach to members on adjudication decisions Outreach to providers offices when additional information is needed Maintain knowledge of CMS & Medi-Cal policy guidelines i.e. Medicare LCD vs NCD Identify & inform Case Management Clinician on complex care diagnoses Read and maintain email inquiries Collaborate with other departments (i.e. Claims, PNO, etc.) to resolve member/provider matters as needed Data entry for additional requested services, as needed Regular attendance at UM team meetings Gather and organize documentation to support care management process Review available information and interview patients to document needs and potential interventions Educate patients about their condition, medication, and available resources Provide input into the care planning process to address their personal health care needs Provide referrals and coordination to access available community resource programs and supports Consult and collaborate with other health care team members and specialists to set up patient appointments and treatment plans Check-in on the patient as designed, evaluate and document progress and coordinate progress with RN CM Assist the care team with developing and assessing effectiveness of healthcare interventions. Minimum Job Requirements High School graduate or GED equivalent Two to three years experience in healthcare Proficient knowledge of medical terminology Proficiency in Microsoft Office programs, especially Word and Excel Proficiency in EZCAP a plus Skills and Abilities Ability to multi-task while remaining adaptable and flexible to fast-paced environment Reliable, dependable and accountable Strong customer service skills with good telephone rapport Ability to empathize with complex cases Self-Motivation and ability to work effectively in an independent environment Great critical thinking and problem-solving skills

Job Type:

Full Time Location:

In Office On-Site Position Benefit Conditions:

Waiting period may apply

Work Remotely No Job Type:

Full-time Pay:

$30.00

• $34.

00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance

Education:

High school or equivalent (Preferred)

Experience:

Customer Service:

1 year (Preferred)

Computer Skills:

1 year (Preferred)

Work Location:

In person