New

Utilization Management Coordinator

TEKsystems
$26.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, California, Bakersfield
Apr 01, 2025
Essential Duties and Responsibilities Screen calls from providers and members regarding the UM process. Obtain referral information from providers and members to implement and facilitate the authorization process. Act as liaison to members, community providers, and employees to the UM clinical staff. Assigns diagnostic and procedural codes using ICD-9 and CPT coding classification system for service requests. Requests input from the Clinical Intake Staff when needing direction or clinical expertise. Reviews specified referral types using workflow and protocols for purposes of pre- authorization of payment; routes requests when indicated to Clinical Intake Coordinators for approval or auto-authorizations. Benefits interpretation to include coordination of care for medically necessary services that are not covered under the Plan (e.g. CCS, Long Term Care, and State Waiver Programs.) Verifies accuracy of components of referral request (i.e. eligibility, network provider status, facility type) for clinical staff for preparation of authorizations for Clinical Intake Coordinator review. Coordination of Health Plan services between UM Department and KHS Member Services and Provider Relations. Reviews member history and eligibility and previous referral authorizations. Monitors, tracks, and processes provider service appeals. Ensures accurate data entry of authorizations in the MHC system. Adheres to Code of Ethics and Business Conduct and all company Policies; e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor. Performs other job-related duties as assigned. Adheres to all company policies and procedures relative to employment and job responsibilities. Additional Skills & Qualifications ICD-9 and CPT coding procedures. Medical Terminology. Minimum of one (1) year of experience in the medical field, preferably in a managed care setting, or one (1) year experience in a medical practice or hospital setting. Data entry and computer experience of at least one year. Experience Level Intermediate Level Pay and Benefits The pay range for this position is $26.00 - $26.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully onsite position in Bakersfield,CA. Application Deadline This position is anticipated to close on Apr 14, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.