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Employment Type:

Full time

Shift:

Description:

*This position is located at the Westchester Office*

Join our dynamic team. The Loyola Physicians Partners, part of the Loyola Health System has an exciting opportunity at our Westchester location. We are currently looking for an experienced Authorization Referral Coordinator. Reporting to the Manager of Utilization Management and working under general supervision, manages Utilization resources and quality of healthcare services through performing initial intake, support and processing of pre-certification requests for eligible members received via portal, EHR, or telephonic, for outpatient and inpatient elective services specified on the preauthorization required list. Utilizes health plan scope of benefits, medical policies, organizational approved medical necessity criteria and home network capabilities to determine if a request meets the guidelines for approval. Approves services

under the supervision of the clinical team per protocol. Refers requests to the nurse reviewer or medical director if criteria or guidelines not met.

*This position is located at the Westchester Office*

Join our dynamic team. The Loyola Physicians Partners, part of the Loyola Health System has an exciting opportunity at our Westchester location.

We are currently looking for an experienced Authorization Referral Coordinator.

This role involves reviewing preauthorization requests, verifying member eligibility, and determining service coverage based on health plan policies, medical necessity criteria, and network availability.

Key Responsibilities:

+ Review, process, and approve pre-certification requests under clinical supervision.

+ Verify documentation, eligibility, and provider/network status.

+ Communicate with providers for additional information and assist with in-network referrals.

+ Escalate requests to nurse reviewers or medical directors when guidelines are not met.

+ Respond to inquiries from providers and members with professionalism and accuracy.

+ Support care coordination, continuous process improvement, and departmental policy development.

Here is what you'll need

Licensure/Certifications

Required:

+ Certified Medical Assistant (CMA) or Registered medical Assistant (RMA) or Licensed practice Nurse (LPN) preferred

Perks & Benefits

+ Benefits from Day One (Medical and Dental)

+ Daily Pay "NEW"

+ Competitive Shift Differentials

+ Career Development

+ Tuition Reimbursement

+ Participation in the Public Service Loan Forgiveness Program

+ 403(b) with Employer Match

+ On Site Fitness Center (Gottlieb Memorial Hospital & LUMC)

+ Referral Rewards

+ Perks Program

Our Promise to You

Joining Loyola Medicine is being a part of an organization that treats the human spirit in our patients and fellow colleagues. We are a part of a community which believes in giving back to those we serve.

+ We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities

+ We live and breathe our guiding behaviors: we support each other in serving, we communicate openly, honestly, respectfully, and directly, we are fully present, we are all accountable, we trust and assume goodness in intentions, and we are continuous learners

Pay Range: $17.30 - 26.81 hourly

_Actual compensation will fall within the range_ _but_ _may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles._

Trinity Health Benefits Summary (https://www.trinity-health.org/sites/default/files/my-benefits/Health-and-Wellbeing/Compliance/Illinois-Transparency-Law/Trinity-Health-Summary-of-Benefits-Illinois-Job-Req-Discloser-Law.pdf)

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran