What are the responsibilities and job description for the Utilization Management Lead position at HIGH DESERT MEDICAL CORP, A MEDICAL GRP?
The UM Lead works under the direction of their Supervisor and UM Director to oversee day to day activities of the Referral Management Department by assisting the Medical Director and Physician Reviewers with obtaining adequate information for making referral determinations, including gathering necessary medical records, clinical review guidelines, health plan and/or regulatory policies, financial/benefit/coverage information, and/or other documentation as needed or requested.
Requirements:- High school graduate or equivalency.
- Current California licensure as a Licensed Vocational Nurse (LVN).
- Ability to communicate effectively with patients, family members, vendors and providers.
- Working knowledge of Word, Excel, PowerPoint, EZ-Cap, Medic, and Report Riter.
- Must have excellent communication skills both verbally and written.
- Ability to handle a multitude of assignments, meeting all given deadlines.
- Knowledge of correct punctuation, grammar and spelling.
- Ability to deal responsibly with matters of a confidential matter.
- Ability to prioritize work in order to meet daily deadlines.
- Ability to work in a multi-task, high productive environment.
- Ability to supervise staff with varying job responsibilities and assignments.
- Ability to analyze routine statistical reports and communicate outcomes to supervisor and/or leadership as needed or assigned.
- Knowledge of inventory control and supply ordering.
- Understanding of current state and federal regulations pertaining to managed care delivery system.
The pay range for this position at commencement of employment is expected to be between $27.00 and $37.18/hr, non-exempt; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
Compensation: $27.00-$37.18
Salary : $27 - $37
