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Under the general direction of the Manager and Supervisor in the Integrated Transitional Care department, the Coordinator - Integrated Transitional Care is a high paced position that requires timely processing of Authorization requests, verifying eligibility, obtaining additional information as requested by the Integrated Transitional Care Nurse. This position requires that one be organized with the ability to multitask with a working knowledge of ICD 10, CPT coding and Medical Terminology. The Coordinator - Integrated Transitional Care will work as an extension of the clinical team to complete all non-clinical functions as indicated, in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.
Key Responsibilities:
Monitor the Right Fax server, EDI Interface, and medical management system intake to all face sheets are processed in a timely manner.
Ensure that hard copy and electronic face sheets are complete and accurate to reflect current Member demographic information.
Review of the daily census report in an effort to eliminate duplicates or other admission received from all contracted and non-contracted facilities not required by the health plan.
Cover Cisco ACD Queue telephone lines and phone queues.
Check eligibility and assigning Authorization to appropriate ITC nurse based on the Far tool.
Attach reviews and orders into the medical management system for review by the ITC nurse
Review and approve service requests within the ITC Coordinator scope as indicated by the Utilization Management Guide approved by the Utilization Management Subcommittee.
Obtain Member discharge dates through daily calls, Electronic Medical Record or memo submissions to contracted and non-contracted facilities.
Meet the performance measurement standards for productivity and accuracy as well as timely processing of inpatient authorizations, inpatient service requests, and discharges.
Assist with the referral process by contacting provider by phone fax or email to request additional medical information as needed.
Set up hospital follow up appts for Member if needed and providing that information to the Member. Documenting the call within the medical management system.
Ensure Members receive Home Health and/or Durable Medical Equipment (DME) items as ordered via phone call and documentation of call within the medical management system.
Process and coordinate disenrollment, transportation as needed
Represent the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
Communicate with providers/facilities in consultation with the ITC Nurse, regarding authorizations, orders, and clinical reviews.
Assist the ITC Nurse in the management and coordination of care of Member identified with care management conditions.
Collaborate on Member’s care issues with other team members and consults with ITC Nurse or ITC management to ensure that the appropriate treatment plan is followed, thoroughly and promptly.
Assist with identifying HEDIS Gaps and outreach to address with Member.
Ensure documentations is accurate and in compliance with regulatory requirements and accreditation standards.
Assist and provide support to Management or Inpatient Clinical Team as requested.
Attend Meetings as scheduled.
Promote a positive and collaborative working environment within the CM Team.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
CalPERS retirement
457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account – Health Care/Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities
Education & Experience
Minimum of two (2) years of experience as a data entry specialist
High School Diploma or GED required
Key Qualifications
Must have a valid California Driver's License
Requires knowledge of ICD 10 and CPT codes
Managed Care or physician office a must
Skilled with computer applications, including word processing, database, and spreadsheets
Good customer service skills
Start your journey towards a thriving future with IEHP and apply TODAY!
Seniority level
Entry level
Employment type
Full-time
Job function
Other
Industries
Hospitals and Health Care
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