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Inpatient Case Coordinator - La Palma, CA-Bilingual Spanish more...
Location:La Palma, CA
First posted:May 12, 2017

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives. As one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high - quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work.(sm) What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

*** Bilingual Spanish Speaking Preferred***

Primary Responsibilities:

Manage administrative intake of members or the admission/discharge information post notification
Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and / or providers
Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
Receive care coordination notification cases for non - clinical assessment / intervention and provide appropriate triage
Review requests for adverse determination, approval notification and processing notification requirements
Assist the clinical staff with setting up documents / triage cases for Clinical Coverage Review
Handle resolution/inquiries from members and/or providers that may include:

Benefit and Eligibility information
Billing and Payment issues
Customer material requests
Physician assignments
Authorization for treatment
Explanation of Benefits (EOB)
Verifying appropriate ICD - 9 and CPT coding usage

Required Qualifications:

HS Diploma or GED

Greater than 1 year experience in managed care environment or medical office or clinic setting

Knowledge of UM / QM processes and principles

Knowledge of training and audit principles and processes

Knowledge of and experience with medical coding

Knowledge of general IPA operations
Preferred Qualifications:

Computer literate in Microsoft Word and Excel

Knowledge of medical terminology

Strong ability to work effectively with nurses, physicians and other clinical and operational staff, both written and verbally

Bilingual Spanish speaking
AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board - certified private - practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Case Coordinator, La Palma, CA, California

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