Description

The Home Health ICM Coordinator plays a key role in supporting our Utilization Management team to ensure safe, high-quality, and cost-effective care for patients enrolled in UCLA Medicare Advantage and Intensive Case Management programs. Under the supervision of the RN Assistant Director, you will coordinate referrals, authorizations, and post-acute services, while helping patients and families navigate their care to reduce hospital readmissions and improve outcomes.

This is a non-clinical role focused on care coordination, oversight of home health services, and administrative support to ensure compliance with CMS guidelines and medical necessity criteria.

Key Responsibilities:

• Coordinate and process urgent, routine, pre-service, and retro authorization requests.
• Support ICM Case Managers in longitudinal care coordination and safe discharge planning.
• Monitor hospital and skilled nursing facility (SNF) admissions and discharges; coordinate transitions of care.
• Develop and implement non-clinical care plans with case management nurses (e.g., transportation, DME, post-acute services).
• Conduct patient and provider outreach to support continuity of care and prevent avoidable hospitalizations.
• Review and track claims, authorizations, and compliance with CMS regulations.
• Maintain accurate records, prepare reports, and support quality improvement initiatives.
• Provide coverage for other coordinators and assist with program operations as needed.