JOB SUMMARY
Under the direction of the Sr. Manager Utilization Management, the incumbent shall serve as the first line coach to the UM Precertification and Concurrent Review Coordinators. The Lead UM Coordinator must be familiar with Community's lines of business, be an expert on template creation, and can quickly and accurately resolve any issue raised by the coordinators or internal/external stakeholders.

JOB SPECIFICATIONS AND CORE COMPETENCIES
Serve as the first line coach to the UM Coordinators. An on the floor floater the Lead UM Coordinator has the experience and overall CHC product acumen, knowledge of template creation to quickly and accurately resolve issues raised by a UM Coordinator and /or internal and external stakeholders. Demonstrates the team desire for turnaround compliance and process improvement, sharing and supporting tasks and training with the UM Leadership team as well as performing UM Coordinator duties. Data entry of admissions, notification of deliveries, sick newborns, and other services. Obtains all pertinent information and medical codes related to the admission, transfer, out of network provider, route of transport, type of service, type of durable medical equipment and other key information. Assists in monitoring reports and refers to appropriate UM Nurse or Manager. Responding and forwarding calls efficiently and in a timely and professional manner to appropriate nursing staff, medical staff, or other departments when appropriate. Review and process fax and telephone requests to meet departmental key metrics and productivity standards, maintain established threshold for case data entry accuracy within compliance timeframes. Actively contributes to achievement of departmental goals, as identified in Departments annual business plan, including specific departmental process improvement plans and other duties as assigned.

QUALIFICATIONS:
Education/Specialized Training/Licensure: High School Diploma or GED required

Two (2) years college education preferred.

Work Experience (Years and Area): Four (4) years experience in healthcare setting such as a medical clinic, hospital, or managed care. Associate or bachelor's degree may be used in lieu of experience.

Medicaid Coding preferred.

Software Proficiencies: Microsoft Office (Word, Excel, Outlook)