Title: Utilization Management Coordinator I (Woodland Hills)
Location: United States-California-Woodland Hills
Other Locations:
Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as 'Part D'), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website atwww.healthnet.com.
JOB SUMMARY:
The Utilization Management Coordinator I coordinates and supports activities related to authorization processing for inpatient and ambulatory services.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
* Receives and enters appropriate information.
* Professionally and efficiently manages intake activities.
* Obtains appropriate information for authorization request entry.
* Requests clinical records per procedure.
* Accurately applies appropriate policies, procedures, and eligibility and benefit policies.
* Refers requests and notifications to appropriately licensed health professional for review.
* Accurately documents all activities as per policy including entry into automated systems.
* Interacts with the providers or members as appropriate to communicate approval outcomes in compliance with state, federal and accreditation requirements.
* Performs hospital notification functions.
* Reports suspected fraud and abuse as per company policy.
* Performs required clerical support duties.
* Meets or exceeds established performance goals including but not limited to service, quality, productivity, turn-around time.
* Effectively applies policies, procedures, and standards; requesting assistance of supervisor, or appropriately licensed health professional when necessary.
* Professionally interacts with customers, acting as a liaison between the beneficiary, provider, facility and Health Net.
* Maintains confidentiality of all PHI in compliance with state and federal law and Health Net Policy.
REQUIREMENTS:
Education:
High School education or equivalent.
Certification/License:
Experience:
* Six months data entry experience.
* Experience in a health care, customer service or a managed care setting preferred.
Knowledge, Skills & Abilities:
* Excellent phone, and verbal and written communications skills.
* Team player who builds effective working relationships.
* Proficient and accurate keyboarding skills.
* Proficient in PC-based software programs.
OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
