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CCS Coordinator *Hybrid*

Company: ApolloMed
Location: Monterey Park
Posted on: November 17, 2022

Job Description:

SUMMARYTo implement the effectiveness and best practices of Utilization Management and provide UM functions anddepartment support to comply with NCQA and Health Plan standards. Reports to the Director of UtilizationReview.ESSENTIAL DUTIES AND RESPONSIBILITIES--- Comply with UM policies and procedures. Annual review of selected UM policies.--- Process Routine & Urgent treatment authorization requests according to the NMM Policy & ProcedureManual based on UM Level review process.--- Meet requirement production requirements, working 30-45 cases per day, such as calling for records,completing the SAR and submitting, following up on previously submitted cases, creating cases for thoseaccepted in to the CCS program.--- Prepare files for health plan audits as needed.--- Accurately review, screen and process referrals in accordance with IPA and health plan TAT guidelines andcompleted daily assignments with accuracy & quality--- Knowledgeable of the California Children's Service (CCS). Understanding of the requirements to enroll inthe program.--- Understanding of the Early Start Program and Regional Centers, coordinate and process referrals as needed.--- Review monthly report to capture possible Early Start or Regional Center referrals. Send letter to the PCPand the member informing them of the programs.--- Work with the provider to obtain required information to submit to CCS.--- Submit required CCS application, release authorization while pending SAR.--- Track and monitor the submissions and follow up as per the internal P&P.--- Track UM TAR referrals that were CCS approved conditions--- Work with Health plans to obtain the required SAR's--- Review daily reports for potential members with CCS valid conditions.--- Responsible for verification to include but not limited to: benefit matrix through DOFR, eligibility, providerstatus (contracted/non-contracted), carved out and others.--- Research problems for treatment authorizations request in a timely fashion--- Attend to provider and interdepartmental calls in accordance with exceptional customer service--- Coordinate all UM activities as assigned.--- Assist with obtaining required documents for CCS, CPSP and Early Start health plan audits.--- Attend to provider and interdepartmental calls in accordance with exceptional customer service--- Performs other duties, projects and actions as assigned.--- Maintains strictest confidentiality at all times.QUALIFICATIONS:1. High School Graduate or equivalent2. A minimum of two years experienced in managed care environment to include but not limited to an IPA orMSO preferred.3. Current knowledge of Managed Care UM procedures4. Knowledge of the Medi-Cal Linked Programs to include CCS, ESPRC5. Knowledge of medical terminology, RVS, CPT, HPCS, ICD-10 codes.6. Proficient with Microsoft applications' and EZCAP7. Good organizational skills.8. Good verbal and written communication skills.8. Must have the ability to multitask and problem solve in a fast pace work environment9. Personal & Professional Qualities#LPIND

Keywords: ApolloMed, Monterey Park , CCS Coordinator *Hybrid*, Other , Monterey Park, California

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