Utilization Management Intensive Case Management Coordinator - After Hours

Take on a vital role within a leading health organization. Help ensure smooth and efficient case management processes to support quality care. Take your expertise to the next level. You can do all this and more at UCLA Health.

Under the direction of the Utilization Management, Assistant Director, you will play a key role in processing and managing authorization requests and care coordination support. You will:

• Receive urgent, routine, pre-service, and retro authorization requests
• Process referrals and authorizations following established procedures within the medical group utilization department
• Prepare and process referrals according to Delegation of Financial Responsibility (DOFR), UCLA Medical Group Medical Guidelines, and health plan contracts
• Identify and prepare necessary documents for the next level of review
• Maintain and prepare specific reports and manage computer applications and logs
• Conduct urgent care coordination needs for complex and high risk population
• Care managed, monitor, coordinate needs of members/patients followed by Case Management
• Work directly with a nurse, ICM team lead and Medical Director.
• Review pending claims for approval or denial