UM Compliance Coordinator - KORE1 Technologies
Fountain Valley, CA
About the Job
KORE1, a nationwide provider of staffing and recruiting solutions, has an immediate opening for a UM Compliance Coordinator in Fountain Valley, Ca.
Position Summary
The Compliance Coordinator is a key leadership support position designed to provide, manage, and document continuous compliance and regulatory activities within the department. This individual will be responsible for the ongoing monitoring and analysis of clinical performance, to assist in the design and implementation of improvement initiatives within medical management. This position is part of a compliance team, reporting to the Compliance Director, and works closely to ensure that all regulatory and compliance reports and tasks are completed in a timely manner.
Essential Functions and Responsibilities of the Job
The Compliance Coordinator is a key leadership support position designed to provide, manage, and document continuous compliance and regulatory activities within the department. This individual will be responsible for the ongoing monitoring and analysis of clinical performance, to assist in the design and implementation of improvement initiatives within medical management. This position is part of a compliance team, reporting to the Compliance Director, and works closely to ensure that all regulatory and compliance reports and tasks are completed in a timely manner.
Essential Functions and Responsibilities of the Job
- Responsible for the on-going training of the Medical Management staff, in partnership with the UM Manager, to stay in compliance with all regulatory requirements.
- Designs, implements and ensures completion of educational materials and attestations for staff as directed to meet regulatory compliance.
- Works closely with the Director to ensure P&Ps meet federal and state regulatory requirements.
- Organizes and maintains filing systems and archival records within the shared drives.
- Schedules and prepares for UM delegation audits, gathering evidentiary documents and referral files, in partnership with the Director
- Collaborates with the Director to schedule and prepare for Committee meetings. This includes taking minutes and ensuring that regulatory items and approvals are documented. Obtains all the necessary signatures to stay in compliance.
- Responds to all appeals for UM referral denials, gathering documents to send to the health plans.
- Back-up for the Denial Coordinator in the writing of all our denial, modification, and carve-out letters
- Works with the other Compliance Coordinator to complete weekly, monthly, quarterly, and yearly regulatory and compliance reports.
- Develops strong and collaborative working relationships with the health plan auditors
- Responsible for working with IT on compliance reports and submitting them timely to health plans
- Responsible for the development and evaluation of the ICE UM Reports and Work Plan
- Conducts internal staff performance audits and Inter-Rater Reliability audits to meet regulatory compliance as it pertains to utilization management activities
- Acts as educator and resource to medical management staff
- Responsible for ensuring that medical management policies are appropriately implemented.
Qualifications
- Minimum 3-4 years of medical management experience, especially in the area of Utilization Management and Health Plan audits
- Experience in EPIC/Tapestry required.
- Experience with Adobe Acrobat required, beyond basic usage
- Knowledge of clinical and medical terminology
- Advanced computer skills in a Microsoft Window environment, especially Excel and PowerPoint, as well as Visio and various healthcare software programs.
- Bachelor's Degree in Healthcare Administration or a healthcare related field of study
ABOUT KORE1
Specializing in professional and technical recruiting, KORE1 is committed to supporting top IT, Engineering, Creative, Scientific, Accounting and Finance professionals in their career paths. We build deep relationships with leading companies, connecting them to exceptional talent every day. With extensive industry expertise and unmatched opportunities, our goal is to provide a unique experience for our contractors and consultants as they prepare for their next role. We are passionate about matching the right people with the right companies.
Specializing in professional and technical recruiting, KORE1 is committed to supporting top IT, Engineering, Creative, Scientific, Accounting and Finance professionals in their career paths. We build deep relationships with leading companies, connecting them to exceptional talent every day. With extensive industry expertise and unmatched opportunities, our goal is to provide a unique experience for our contractors and consultants as they prepare for their next role. We are passionate about matching the right people with the right companies.
Kore1 provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Kore1 complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Kore1 expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Kore1's employees to perform their job duties may result in discipline up to and including discharge.
Source : KORE1 Technologies
