Medical Authorization Assistant (Concurrent Review)

Department(s): Utilization Management, Concurrent Review
Reports to: Supervisor Utilization Management
FLSA status: Non-Exempt
Salary Grade: C - $43,281 - $61,798


Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Friday , August 11, 2023 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima Health.

About the Position

The Medical Authorization Assistant (Concurrent Review) will provide office and referral management support services, assist the inpatient Medical Case Managers in obtaining medical records, document all case information in the system, perform data entry into appropriate databases for monitoring and tracking and follow up on phone calls as directed by the Medical Case Managers. The incumbent will serve as the contact between members, physicians, facilities, providers and CalOptima Health staff. The incumbent will be responsible for processing the intake information and assisting with authorization functions. The incumbent will also perform office support functions as needed.




Duties Responsibilities:

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Documents all contacts and case information in the system using the standard charting format.
• Verifies member eligibility.
• Authorizes requested services according to CalOptima Health's Concurrent Review team guidelines. Contacts the health networks and/or CalOptima Health Customer Service regarding health network enrollments.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Completes other projects and duties as assigned.
• Collects additional information from CalOptima Health members and/or providers/facilities to complete prospective, concurrent or retrospective inpatient service reviews.
• Receives inpatient requests via fax, phone or electronically and enters data of new case information into the medical management system.
• Enters data into the appropriate databases for monitoring and tracking, trending of inpatient events and other relevant databases as needed.
• Creates inpatient events based on facility face sheets and/or clinical received.
• Assists the inpatient Medical Case Manager in gathering medical records, obtaining appropriate coding for diagnosis and procedures, discharge dates, dispositions and conducts follow-up phone calls per concurrent review team standards.

Experience & Education:

• 2 years of experience in a health care or managed care setting required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
• High School diploma or equivalent required.

Preferred Qualifications:

• Concurrent Review and Utilization Management experience.
• Certified Medical Assistant (CMA) certification.
• Previous medical billing and coding experience.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).

Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of the job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time and work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for frequent phone use, in meetings and face-to-face interaction.

• Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.


CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.


If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.



Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4347

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