Children's Physicians Medical Group (CPMG) is a pediatric-only Independent Physicians Association (IPA), associated with Rady Children's Hospital - San Diego. Its provider network includes 220 primary care pediatricians and 300 pediatric subspecialists. These providers in conjunction with Rady Children's Hospital have formed an Integrated Delivery System (IDS) known as Rady Children's Health Network (RCHN). Currently, 74,000 children are enrolled in CPMG through seven managed care Health Plan contracts. Additionally, CPMG and its network partners provide MSO services to 400,000 patients and their providers in San Diego, Southern Riverside, and Orange County.
CPMG is currently seeking qualified candidates for the position of Utilization Management Coordinator. This position communicates with members, providers, and health plans through the prompt, accurate and courteous resolution of issues; 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. Utilization Management Coordinator duties will also include: data entry/processing of authorization requests, including verification of benefits, research of authorization history, provider notes, use of correct CPT/ICD9 codes; providing referrals within CPMG network; working collaboratively with all professional entities relating to CPMG business; and assisting colleagues as necessary on special projects with time critical deadlines.
- 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.
We conduct pre-employment background checks and drug screens as conditions of hire. 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. Job offer is contingent on successful participation in Children’s Physician Medical Group (CPMG) COVID-19 Vaccination Policy.
For consideration please email resume and cover letter including salary requirements. Children’s Physician Medical Group offers the full scope of benefits, a great compensation package and opportunities for professional growth. An Equal Opportunity Employer.
Job Type: Full-time
Pay: $20.00 - $22.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Shift:
Weekly day range:
COVID-19 considerations:
Job offer is contingent on successful participation in Children’s Physician Medical Group (CPMG) COVID-19 Vaccination Policy.
Work Location: In person
