Senior Utilization Management Coordinator July 2007-May 2011
Utilization Management Coordinator II Dec. 2005-July 2007
Oversee team in two states for the prior authorization and hospital notification departments for Arizona Medicaid, Commercial, and Medicare programs with experience managing Oregon, and Washington Commercial and Medicare programs. Act as a subject matter expert for all non-clinical medical management operations for these states for project management teams pertaining to system enhancements, upgrades and new business. Write desktop policies and procedures affecting all non-clinical medical management associates. Work closely with Case Management, Provider Network Management, concurrent and prior auth clinical team, Medical Directors, claims, sales, and customer service to resolve member and provider issues quickly and efficiently. Responsible for maintaining and monitoring Medicare, NCQA and DOI turn-around times, quality customer service with inbound queue calls, inbound faxes and review of authorization requests for medical services. Resolve complex issues with providers, members, ad-hoc reporting, audits and claims. Primary liaison for outside vendors and delegated entities for Arizona business. Primary contact for all non-clinical medical management issues internally and externally. Responsible for resolving file errors and rejections involving 278, 997, and 999 files from radiology and radiation vendor for all CA, OR, AZ, and WA lines of business. Participate in projects for the Affordable Care Act exchange programs. Coordinate user acceptance testing between IT and my department for new system releases in Arizona and California. Conduct performance reviews, mentoring, coaching, interviewing, training, and motivation.
