UTILIZATION MANAGEMENT COORDINATOR – Level 1 (non-clinical)

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Children’s Physicians Medical Group (CPMG) is a pediatric-only Independent Physicians Association (IPA), affiliated with Rady Children’s Hospital – San Diego and Rady Children’s Specialists of San Diego.  These providers have formed an Integrated Delivery System (IDS) known as Rady Children’s Health Network (RCHN), which includes 200 primary care pediatricians and over 450 pediatric specialists. Currently, over 78,000 children are enrolled in CPMG through nine managed care Health Plan contracts and three Medi-Cal contracts. Additionally, CPMG and its network partners provide MSO services to 400,000 other patients and their providers in San Diego, Southern Riverside, and Orange County.

UTILIZATION MANAGEMENT COORDINATOR – Level 1 (non-clinical)

CPMG is currently seeking qualified candidates for the position of Utilization Management Coordinator – Level 1 (non-clinical). This position communicates with members, providers, and health plans through the prompt, accurate and courteous resolution of a variety of issues.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Receives and respond to customer inquiries (telephone, written and electronic) that may pertain to all phases of CPMG operations including authorizations, claims inquiries and provider network access.
• Documents all customer contacts, including resolution or action taken to refer question to proper entity
• Assists and educates member families with navigation of HMO processes. 
• Data entry/processing of authorization requests, including verification of benefits, research of authorization history, provider notes, use of correct CPT/ICD9 codes.
• Provides referrals within the CPMG network.
• Works collaboratively with all professional entities relating to CPMG business.
• Assists colleagues as necessary on special projects with time critical deadlines.

REQUIREMENTS

• High School diploma and previous experience in the health care field, such as hospital, medical group, health insurance, or other Risk Bearing Organization (RBO). Bachelor’s Degree will be considered in lieu of experience.
• Medical Terminology, ICD-10 Codes, CPT Codes, HCPC Codes, Health plan benefits, or claims preferred. Computer skills a plus, specifically Excel, EZ-Cap, Word, Outlook, Internet/Web searching, and Epic.

The reasonably expected starting hourly wage range for this position is $20.00-$22.00 depending on qualifications including education and relevant experience.

Job offer is contingent on successful participation in Children’s Physician Medical Group (CPMG) COVID-19 Vaccination Policy. For the safety and well-being of our pediatric community, many of whom are not eligible for their COVID-19 vaccine yet, CPMG requires that all staff be vaccinated against the COVID-19 virus.

Children's Physicians Medical Group offers the full scope of benefits, a great compensation package and opportunities for professional growth. EOE. For more information, please visit our website www.cpmgsandiego.com. This position is in San Diego, CA.

TO BE CONSIDERED FOR ANY OPENINGS, PLEASE SUBMIT A LETTER OF INTEREST AND RESUME TO HUMAN RESOURCES AT [email protected]