Job Description

Payroll Title:
BLANK AST 3 PD
Department:
PHSO - CLINICAL OPERATIONS
Hiring Pay Scale
$31.32 / Hour
Worksite:
Greenwich Drive
Appointment Type:
Per Diem
Appointment Percent:
20%
Union:
CX Contract
Total Openings:
1
Work Schedule:
Days, 8 Hour Shifts, Monday-Friday, may vary

#133257 PHSO UM Referral Coordinator - Per Diem - Hybrid

Filing Deadline: Wed 12/11/2024

UC San Diego values equity, diversity, and inclusion. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.

DESCRIPTION

Under the direction of the Assistant Director, the Population Health Managed Care Per Diem Utilization Referral Coordinator is responsible for processing a high volume of HMO prior authorization requests. They will ensure that the orders / referrals are part of the Health Plan benefit or escalate the referral to the RN Care Management team. The UM Referral Coordinator works in Epic, health plan portals, right fax, and other internal systems to process referrals timely. UM Referral coordinator approves certain inpatient and outpatient authorizations at a coordinator level per UM guidelines and processes carve out/non covered benefit authorizations. UM Referral Coordinator reviews and processes retro claim UM requests for authorization.

The UM Referral Coordinator works closely with the High Risk Case Managers, Social Worker, and Pharmacists as key members of the interdisciplinary care team. Will assist in helping members navigate the complex health system; assist with redirections, help schedule appointments, identify and coordinate resources, educate patients on the provider's treatment plan, promote self-efficacy, and identify & resolve any barriers.

Once fully trained, this position will have the option to work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive and remotely.

Holiday and weekend availability is required.

MINIMUM QUALIFICATIONS

  • Experience working in a health care setting.

  • Previous front and back office Primary Care office experience.

  • Previous experience working in the community with health education for vulnerable populations, understanding of social factors that contribute to the need for help with health system navigation for wellness.

  • Excellent communication skills both verbally and in writing.

  • Knowledge in MS office (Excel, PowerPoint, Outlook, Word, Rightfax, etc.).

  • Demonstrated ability to coordinate and research the review of difficult, complex Utilization Management issues.

PREFERRED QUALIFICATIONS

  • Highly desired experience within HMO or IPA/MSO utilization management /prior authorization department; high volume.
  • Good knowledge of HMO benefits/policies for authorization; Understanding of Division of Financial Responsibility (DOFR.
  • Strong understanding of Medicare, Commercial health plan benefits.
  • Experience with processing retro claims/UM authorizations.
  • Electronic Medical Record/ Epic experience.
  • Experience working in a remote environment.
  • Experience working on a multidisciplinary team.

SPECIAL CONDITIONS

  • Must be able to work various hours and locations based on business needs.
  • Employment is subject to a criminal background check and pre-employment physical.
  • Holiday and weekend availability required.
  • Employee required to have consistent high-speed internet and appropriate workstation when working remotely.

Pay Transparency Act

Annual Full Pay Range: $65,396 - $65,396 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: $31.32 - $31.32

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).


If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

UC San Diego is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California’s Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20
For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

a. "Misconduct" means any violation of the policies or laws governing conduct at the applicant's previous place of employment, including, but not limited to, violations of policies or laws prohibiting sexual harassment, sexual assault, or other forms of harassment, discrimination, dishonesty, or unethical conduct, as defined by the employer. For reference, below are UC's policies addressing some forms of misconduct:

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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