Job Description

Join Cedars-Sinai!

Cedars-Sinai has been named to the Honor Roll for the ninth consecutive year and tied for #1 in California and Los Angeles in U.S. News & World Report’s “Best Hospitals 2024-25” rankings, as well as placed among the very best in 11 specialties nationwide.

Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded the Advisory Board Company’s Workplace of the Year. This recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.

Why work here?

Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) we take pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation.

A Little More About What You Will be Doing

The Case Management Coordinator provides support to the utilization review process. The coordinator works collaboratively with all team members of Utilization Management, Patient and Provider Services, Claims Department and other Care Coordination Department staff. In addition, the coordinator assists in identifying, tracking and coordinating services for patients when needed. The position requires good written and communication skills and the ability to interact with Medical Directors, Providers, CSMNS members, Medical Group and IPA's to ensure the delivery of high quality, cost effective healthcare and aligned with all state and federal regulations and guidelines.

Job duties and responsibilities:

Enters data and processes referral authorization requests, to include appropriate coding and quantities.Answers incoming calls from Providers, IPAs, Medical Groups and other internal and external calls and assists on the queues as needed.Monitors the Fax Inbox and appropriately distributes incoming faxes. Ensures that internal compliance security measures are met.Verifies member eligibility before processing authorizations.Contacts facilities identified by the UM Nurses/Manager/Director/Medical Director to research any issues (i.e. contract, discharges, services provided).Identifies non-contracted providers and requests Letter-of-Agreements when requested.Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors, or Management.Processes Extensions and Denial Letters, when needed.Prepares Utilization Review Reports as necessary.Assists the Case/Care Managers in coordinating and arranging services for members.Provides assistance to the Claims Department, when requested.Documents all patient specific information in appropriate information systems.Assists in verifying health plan benefits and coordinating ambulatory services.Monitors the turn around timeframes for referrals.Responds to variations in daily workload by evaluating task priorities according to department.
Qualifications

Education:

High School Diploma or GED required

Experience:

1 year of healthcare experience, a general knowledge of medical terminology and experience with community resources and social supports required. 1 year of previous utilization management or managed care experience; word processing spreadsheet skills also preferred.
Req ID : 10884
Working Title : Case Management Coordinator - MNS Ambulatory Care Management
Department : MNS Ambulatory Care Mgmt
Business Entity : Cedars-Sinai Medical Center
Job Category : Patient Services
Job Specialty : Case Management
Overtime Status : NONEXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $23.47 - $35.21