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Hours Full-time, Part-time
Location Irvine, CA
Irvine, California

About this job


For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
 
As a Utilization Management Coordinator based out of our Irvine, CA office, you'll be responsible for providing data entry support, assisting the Case Managers in meeting coordination of care needs for our Monarch Healthcare members.  This includes and is not limited to entering and processing prior authorizations, verification of Health Plan eligibility and benefits, opening of clinical cases with preliminary information, attaching faxes to clinical records, tracking data by facility, generating and analyzing reports along with assisting with correspondence and communication under the direction of case managers and utilization review staff.
 
Primary Responsibilities:

Receives and responds to telephone calls through the UM Phone Queue
Data entry of information received via fax or phone calls
Phone call outreach to providers for information and clarification to help authorization process
Interfaces with other departments via electronic and phone communication
Works in multiple software systems
Coordinates initial screening for UM service requests via phone, web portal, mail and fax
Prepares files for UM Nurses for review
Monitors work flow to ensure files are addressed within turnaround times
Reviews health plan web sites for benefit and eligibility information
Performs all other related duties as assigned

Requirements


Required Qualifications:

High School Diploma/GED
Working knowledge of medical terminology 
Preferred Qualifications:

Bilingual in English/ Spanish or English/Vietnamese or English/Farsi
HMO, Medi-Cal, Medicare and health services experience
Knowledge of Medicare and Medi-Cal eligibility and benefits
Medicaid and Medicare knowledge
Healthcare experience and/or working with seniors or persons with disabilities
What happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining Optum and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, quality care, and working together to improve the patient experience. It takes passion, commitment, focus and the ability to contribute effectively in a highly collaborative environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm)
 
 
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
Job Keywords: Patient Care Coordinator, UM Patient Care Coordinator,Utilization Management, Irvine, CA, California