APPLECARE Case Manager Coordinator

UnitedHealth Group - La Palma, CA3.6

Full-time
Like you, UnitedHealth Group is strong on innovation. And like you, we'll go the distance 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 a chance to make an impact.

Schedule: Saturday-Wednesday 8am-4pm Office based in La Palma, CA

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
Facilitates the authorizations for discharge planning
Coordinate in network hospital transfers
Assist the clinical staff with setting up documents / triage cases for Clinical Coverage Review

Handle resolution/inquiries from members and/or providers:
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 / Inpatient processes
Knowledge of general IPA operations

Preferred Qualifications:
Bilingual Spanish speaking preferred
Computer literate in Microsoft Word and Excel
Knowledge of medical terminology
Knowledge of medical coding
Strong ability to work effectively with nurses, physicians and other clinical and operational staff, both written and verbally

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.