Coordinator - LTC Job Openings by Inland Empire Health Plans in Rancho Cucamonga
30+ days ago
Inland Empire Health Plans
Inland Empire Health Plans Recruitment 2020 - Inland Empire Health Plans is looking for the candidates to fill Coordinator - LTC that will be placed in Rancho Cucamonga.
Inland Empire Health Plans Jobs 2020
Detail of : Coordinator - LTC Job Opening in Rancho Cucamonga
Team Members are eligible to apply for a transfer or promotion after successfully completing their six-month introductory period AND have no open/active performance improvement plan (PIP). In addition, Team Members must meet the minimum requirements of the position for which they are applying. Member Services Representatives and Registered Nurses must complete one year of service in their current role as well as the requirements above.
Under the general direction of the Long Term Care Nurse Manager and Supervisor, the LTC Coordinator is a high paced position that requires timely processing of authorization requests, verifying eligibility, obtaining additional information as requested by the Long Term Care Review Nurses, managing LTC reports, assisting with skilled nursing placement, and review of custodial documentation received by the facilities. This position requires that one be organized with the ability to multi-task with a working knowledge of ICD.10, CPT Coding and Medical Terminology. The UM Coordinator will also ensure that provider calls are responded to in an accurate and timely manner. Major Functions (Duties and Responsibilities)
1. Responsible for monitoring the Right Fax Server for the long term care team. Ensuring all orders are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
2. Responsible for meeting the performance measurement standards for productivity and accuracy for processing of orders/admit facesheets.
3. Responsible for representing the in a friendly and professional manner while answering the calls for the Utilization Management Department.
4. Communicate with providers in consultation with the Long Term Care Review Nurse, regarding authorizations, denials and other matters pertinent to processing authorization requests or other UM related correspondence.
5. Assist Management or Utilization Management Nurses as requested.
6. Assist with placement of IEHP Members to long term care from the community and those transitioning from an inpatient facility.
7. Attaching reviews and orders into the medical management system for review by the Long Term Care Review Nurse.
8. Performs basic, initial review of the Minimum Data Set (MDS) received on each custodial care Member from the skilled nursing facility.
9. Verify eligibility on each Member in long term care at the beginning of each month
10. Create authorization for bed holds and follow up to determine if Member has returned to the original facility and complete authorization. Experience Qualifications
Minimum of three years of experience as a data entry specialist. Preferred Experience
Utilization Management experience preferred. Data entry specialist experience preferably in an HMO or Managed Care setting. Education Qualifications
High school diploma or GED required. Professional Certification
Medical assistant certification preferred. Knowledge Requirement
Knowledge of computer applications, including word processing, database and spreadsheets. Requires knowledge of ICD-9 and CPT codes. Understanding of and sensitivity to multicultural community. Knowledge of CMC and Medi-Cal/managed care environment. Abilities Requirement
Telephone courtesy. High degree of patience. Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear;
For further information, please refer official source from Inland Empire Health Plans on following link below. To find out where you fit in, please visit :
All application will kept strictly confidential.
Only short-listed candidates will receive responses.
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