Health Plan Liaison

Summary The Health Plan Liaison is the main point of contact between Outpatient UM team members and Health Plan personnel. This role oversees referral requests that are delegated to the Health Plans (i.e. tertiary, DME, pharmacy, etc.), from the initial provider request until the final decision from the Health Plan is made. Reporting to the Outpatient UM Manager, the Health Plan Liaison adheres to MPM company policies and procedures. Duties and Responsibilities: Communicates with OP UM nurses and coordinators to identify Health Plan delegated decisions Completes Health Plan service request form and submits for decisions (via email and/or fax) Assures that sent requests are complete with all necessary clinical and member information required for review Assures that requests adhere to CMS and DMHC regulations for timeliness standards Contacts provider offices for additional member information, as needed Outreach to Health Plans for updates on outstanding requests Updates authorization status and documents Health Plan decisions in EZ CAP database Assists the Client Support Center with a high volume of calls, as needed Assists other team members with their workload, as needed Regular attendance at UM team meetings Minimum Job Requirements: High School graduate or GED equivalent 1 year of experience in the medical field Knowledge of medical terminology Proficiency in Microsoft Office programs, especially Word and Excel Proficiency in EZ CAP a plus Skills and Abilities: Strong customer service skills with good telephone rapport Ability to multi-task while remaining adaptable and flexible to fast-paced environment Strong verbal and written communication skills Salary Range: $19 – $21 hourly