IEHP

Nonprofit public health plan for the Inland Empire

Integrated Transitional Care Coordinator

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours

Full-timeRancho Cucamonga, CA, USA$23.98 - $30.57 /hr

About the Job

Requirements

At least two years of experience as a data entry specialist.
A high school diploma or GED is required.
A valid California driver's license is required.
Knowledge of ICD-10 and CPT codes is required.
Experience in managed care or a physician's office is required.
Proficiency with computer applications, including word processing, databases, and spreadsheets, is required.
Good customer service skills are required.

Responsibilities

Monitor the RightFax server, EDI interface, and medical management system intake to process all face sheets in a timely manner.
Ensure hard-copy and electronic face sheets are complete and accurately reflect current member demographic information.
Review the daily census report to eliminate duplicate admissions and admissions received from contracted and non-contracted facilities that are not required by the health plan.
Cover Cisco ACD telephone lines and phone queues.
Check eligibility and assign authorizations to the appropriate Integrated Transitional Care nurse using the Far tool.
Attach reviews and orders in the medical management system for review by the Integrated Transitional Care nurse.
Review and approve service requests within the Coordinator's scope, as indicated by the Utilization Management Guide approved by the Utilization Management Subcommittee.
Obtain member discharge dates through daily calls, electronic medical records, or memo submissions to contracted and non-contracted facilities.
Meet productivity and accuracy performance standards and process inpatient authorizations, inpatient service requests, and discharges on time.
Support the referral process by contacting providers by phone, fax, or email to request additional medical information as needed.
Arrange hospital follow-up appointments for members when needed, provide appointment information to members, and document calls in the medical management system.
Ensure members receive ordered home health or durable medical equipment items through phone follow-up and documentation in the medical management system.
Process and coordinate disenrollment and transportation as needed.
Answer calls for the Utilization Management Department while representing the health plan in a friendly and professional manner.
Communicate with providers and facilities, in consultation with the Integrated Transitional Care nurse, regarding authorizations, orders, and clinical reviews.
Assist the Integrated Transitional Care nurse with management and care coordination for members identified with care management conditions.
Collaborate with team members on member care issues and consult the Integrated Transitional Care nurse or management to ensure the appropriate treatment plan is followed thoroughly and promptly.
Help identify HEDIS gaps and conduct outreach to address them with members.
Ensure documentation is accurate and complies with regulatory requirements and accreditation standards.
Provide support to management or the inpatient clinical team as requested.
Attend scheduled meetings.
Promote a positive and collaborative working environment within the case management team.

Desired Qualifications

Data entry specialist experience in an HMO or managed care setting is preferred.
Utilization management experience is preferred.
Knowledge of utilization management in a health care delivery setting is preferred.

Overview

This is a short-term assignment.

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

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.

Applicable to Bilingual job code only - This is a Bilingual (English/Spanish) position. The Team Member in this role must take a language proficiency assessment and must receive a passing score

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.

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.

Qualifications

Education & Requirements

Minimum of two (2) years of experience as a data entry specialist
Data entry specialist experience preferably in an HMO or Managed Care setting
Utilization Management experience preferred
High School Diploma or GED required

Key Qualifications

Must have a valid California Driver's License
Requires knowledge of ICD 10 and CPT codes
Knowledge of utilization management in a health care delivery setting preferred
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!

Work Model Location

Word processing and data entry involving computer keyboard and screens, distribution of reports, filing and copying of records and/or correspondence. Position is eligible for telecommuting/remote work location model upon completing the necessary steps and receiving HR approval. The incumbent approved to telecommute may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership.

Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.

Pay Range

USD $23.98 - USD $30.57 /Hr.

Compensation: 23.98 to N/A (USD)

About the Company

IEHP

Nonprofit public health plan for the Inland Empire

IEHP is a nonprofit public health plan that connects residents of California's Riverside and San Bernardino counties with health coverage and care. It administers Medi-Cal coverage for eligible low-income residents, IEHP DualChoice for people with both Medicare and Medi-Cal, and IEHP Covered plans through Covered California. Members receive care through a network of doctors and other providers, with dedicated care teams for those who need extra support. Its community wellness centers run free fitness classes and health workshops, and it connects residents with food and housing resources. IEHP began operating in 1996 and is headquartered in Rancho Cucamonga, California.

Company size: 1,001-5,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Rancho Cucamonga, CA
Founded: 1996

Recently Posted Jobs

Explore more opportunities at IEHP

See more jobs