Job Information
Robert Half Associate Clinical Administrator Coordinator in Bakersfield, California
Description
We are looking for a meticulous and dedicated Associate Clinical Administrator Coordinator to join our team in the healthcare industry, remote to candidates IN CALIFORNIA. As a Clinical Administrator Coordinator, you will be responsible for providing non-clinical support to the utilization management team in maintaining and managing the utilization processes for pre-service authorization requests in a timely and accurate manner consistent with policies and procedures as described in the Utilization Management plan. The Clinical Administrator Coordinator role offers a long-term contract employment opportunity.
Responsibilities:
□ Provides non-clinical support to the CDU nurse in the processing of all adverse determinations and notices including provider outreach for denial avoidance, accessibility verification and benefit validation.
□ Ensures informational notices for carve outs and benefits are composed in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA standards.
□ Converts service description and diagnosis into language that is easily understood based on resources provided and clinical direction.
□ Validates the accuracy of all information provided in the carve out and benefit notices including carve out providers and contact information provided relevant to aforementioned notices.
□ Contacts members or providers for continuity of care services related to carve out notices.
□ Adheres to the standardized documentation requirements for carve out and benefit notices.
□ Documents members’ service benefits by contacting the appropriate health plans.
□ Directs providers and members to contracted provider network and facilities.
□ Processes appropriate authorizations for HMO / PPO clients as specified in the organization’s procedures.
□ Acts as a resource to other coordinators, staff and providers by resolving issues and responding to requests in a timely and effective manner.
Requirements
Minimum:
1 year of experience performing non-clinical functions for prospective UM review.
Preferred:
1 year of experience providing supportive or direct functions for adverse determinations.
3 to 5 years of experience in a health care setting.
2 years referrals management or related experience.
KNOWLEDGE, SKILLS, ABILITIES:
Proficient in Microsoft Office Suite, knowledge of utilization management platforms and the capacity to navigate varied health plan websites for benefit determinations.
Ability to type 30 wpm.
Broad knowledge of managed care principles.
Knowledge of medical terminology and CPT/ICD-9 coding.
Excellent communication, organization and customer service skills.
Proven ability to problem-solve.
Strong attention to detail.
Ability to manage time effectively and work independently.
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
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