An exciting new opportunity exists for a Utilization Management Coordinator with Affinity Medical Solutions in Richmond, CA, affiliated with University HealthCare Alliance (UHA), Stanford Hospital & Clinics' new medical foundation.
The Utilization Management Coordinator is responsible for processing inpatient and outpatient provider authorization requests to ensure member eligibility and benefit availability while focusing on the use of preferred providers. This position completes approvals with required documentation within regulatory timeframes and will notify members and providers of determinations per requirements.
The ideal candidate will have two (2) years of college education and at least two (2) years of work experience in a managed care environment having utilized managed care systems, regulations, CPT, ICD-9, and HCPCS codes. A general knowledge of ancillary and hospital based services and contracts, healthcare claims processes, capitation, healthcare operations and familiarity with various healthcare delivery models are also required. He/she will have experience in various system software and Microsoft programs such as Windows, Microsoft Word, Excel (PowerPoint a plus).
BA/BS Degree, Medical Assistant certificate, or IPA or Health Plan experience in a utilization management/prior authorization setting is preferred.
Please submit your resume and cover letter.
Equal Opportunity Employer