Position Overview

Ultimate Staffing Services is actively seeking a Medical Management Care Coordinator I for an established client located in San Jose, CA. This position requires the individual to perform non-clinical supportive duties related to utilization management (UM) and care coordination for members. The role is full-time and is conducted entirely onsite in California.

Responsibilities

• Follow established Health Services policies and procedures and use available resources to respond to member and/or provider inquiries and resolve any concerns in an accurate, timely, respectful, professional, and culturally competent manner.
• Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfaction.
• Develop effective and professional working relationships with internal and external stakeholders and partners. Communicate effectively with members and providers orally and in writing.
• Assist in gathering and processing data for internal required reports and analysis.
• Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training, and coaching sessions.
• Follow UM policies and processes to the management of incoming authorization requests received through fax, mail, or telephone.
• Identify authorization requests for line-of-business, urgency level, type of service, and assess for complete/incomplete record submission.
• Perform complete, accurate, and consistent data entry into system software applications in accordance with policies, procedures, and instruction from UM management.
• Answer inbound UM phone queue calls timely to assist members and/or providers regarding inquiries involving authorizations, program services, and/or benefits.
• Process written and verbal notifications of authorization determinations to members and/or providers within regulatory processing timeframes.
• Perform other duties as required or assigned.

Qualifications

• High school diploma or GED. (Required)
• Minimum two years of experience in a health care setting in positions requiring interaction with members and/or providers. (Required)
• Knowledge of health plan benefits, process, and operations related to commercial, Medi-Cal, and/or Medicare programs. (Desired)
• Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone tasks to support department operations as dictated by business needs. (Required)
• Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (Required)
• Demonstrated ability to consistently meet Key Performance Indicators by participating in and achieving the standards put forth to achieve the standard requirements of the Utilization Management Department. (Required)
• Ability to work within an interdisciplinary team structure. (Required)
• Work weekends and company holidays as needed based on business and regulatory requirements. (Required)
• Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific UM programs. (Required)
• Ability to use a keyboard with moderate speed and a high level of accuracy. (Required)
• Excellent communication skills including the ability to express oneself clearly and concisely when providing service to internal departments, members, providers, and outside entities over the telephone, in person, or in writing. (Required)
• Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (Required)
• Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (Required)
• Ability to maintain confidentiality. (Required)
• Ability to comply with all policies and procedures. (Required)
• Ability to perform the job safely and with respect to others, to property, and to individual safety. (Required)

Work Hours

Monday - Friday, 8:00 AM - 5:00 PM

Benefits

The position offers a competitive hourly wage, with a minimum pay of $26 and a maximum pay of $30.

Additional Details

This position is 100% onsite in San Jose, CA. Candidates must be comfortable with frequent contact and interruptions by co-workers, supervisors, and members or providers in person, by telephone, and by work-related electronic communications.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.