Sutter Health Managed Care Coordinator- Managed Care- Burlingame in Burlingame, California
Effectively process referral requests for PAMF patients within and outside of PAMF to achieve timely and accurate determinations. Referrals are service requests that may require authorization to ensure payment. Works within scope of practice to complete or forward requests as appropriate to Managed Care physicians and/or nurses as per the Utilization Management (UM) protocols. Maintain required turnaround times for referral completion. Assist providers and patients with referral status questions. Participates in development and implementation of improvements to the referral process and workflows.
REQUIRED : high school diploma or equivalent; one (1) year medical terminology; must have computer skills including data input around 60-70 wpm; working knowledge of MS Office Excel and Word, other Managed Care related programs
PREFERRED : two (2) or more years of work experience directly related to supporting Managed Care functions for acute care, medical group, or other managed care setting; one (1) or more years direct prior authorization administration experience in an insurance company or Managed Care area including health plan benefit interpretation; one (1) or more years pharmacy technician experience; one (1) or more years of work experience related to CPT/HCPCS/ICD-9 coding
Primary Location: California, Peninsula/South Bay and Santa Cruz, Burlingame
Organization: Palo Alto Medical Foundation
Employee Status: Regular
Position Status: Non-Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: None
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.