Providence is calling a Utilization Management Trainer ( Full Time / Day Shift ) to our Facey Utilization Management location in Mission Hills, CA.
In this position you will:
Provide initial and ongoing training to all UM staff (Request Specialist, Discharge Planner, Case Managers, other UM positions as needed).
Be responsible for understanding business and clinical workflows and updating of educational materials, cheat sheets, flowcharts.
Utilize referral experience with DME, home health, hospice, injectables and discharge planning.
Demonstrate job proficiency as Request Specialist.
Serve as a liaison between patients, hospitals and the organization.
Required qualifications for this position include:
Minimum of two years of experience in a clinic, hospital or related health care industry in a managed care environment.
Demonstrates competency and knowledge in HMO/EPO/PPO eligibility and benefit coverage/criteria/insurance processing, ICD-9/CPT coding and medical terminology.
Proficiency in DME, Home Health, Hospice and Injectible referral benefits in an HMO environment.
Knowledge of managed health care market place, health delivery systems, contract basics.
Strong quantitative and analytical skills and ability to meet critical deadlines.
Ability to compose letters, correspondence and create reports from data bases.
Knowledge of ICE, CMS, NCQA, DMHC, ADA and HIPAA regulations.
Ability to handle multiple tasks including project management.
Extensive knowledge of personal computer and familiarity with assorted office equipment (i.e. fax photocopier, telephone and keyboard).
Excellent office and administrative skills.
Proficient in MS Office: Word, Excel, Power Point, Access.
Must have technical expertise in GE Centricity/IDX, other UM software, EHR.
Ability to use 10-key calculator by touch, type 45 wpm.
Excellent customer service skills.
Must have initiative and use proper judgment with minimal supervision.
Must be detail-oriented, organized, possess ability to prioritize and manage multiple projects with clearly stated timeliness.
About organization you will serve:
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita, and Simi Valleys. The group began as a single medical practice over 90 years ago.
Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.