DaVita Care Coordinator- Costa Mesa in COSTA MESA, California
Care Coordinator- Costa Mesa
DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Nevada, New Mexico, Florida, Colorado and Washington in its pursuit to deliver excellent-quality health care in a dignified and compassionate manner. As of June 30, 2016 DaVita Medical Group (formerly HealthCare Partners) provided integrated care management for approximately 760,000 patients. DaVita Medical Group’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.
We are committed to bringing the benefits of coordinated care to our patients and to taking a leading role in the transformation of the national healthcare delivery system to assure quality, access, and affordable care for all.
If you're looking to make a difference with a large, financially stable, well-recognized medical group, DaVita Medical Group may be the employer for you.
Responsiblefor maintaining and managing the internal and external utilization processes ina timely and accurate manner consistent with HealthCare Partners’ (HCP)policies and procedures as described in the Utilization Management Plan.
Consistently exhibits behavior and communicationskills that demonstrate HealthCare Partners’ (HCP) commitment to superiorcustomer service, including quality, care and concern with each and everyinternal and external customer.
Performs effective prospective and concurrentreview of requested services according to established guidelines andtimeframes.
Documents members’ service benefits by contactingthe appropriate health plans as needed.
Directs providers/members to contracted provider networkand facilities.
Processes appropriate authorizations for HMO/PPOclients as specified in the HCP procedures.
Prints and mails authorizations to providers,patients, HMOs and facilities as needed.
Assists and monitors in the processing ofreferrals. Enters, updates and closesreferrals daily while assuring that appropriate internal/external referralproviders are utilized, members are eligible and have benefits coverage, correct CPT/ICD-9 codeshave been entered, accurate records of all dates and other required fields areentered, supporting clinical data for the referrals is entered, and all urgentreferrals are processed within the designated timeframe.
Processes referrals for durable medical equipmentand coordinates home health services according to established policies,procedures and guidelines.
Processes elective surgical requests including thecoordination of surgery dates and notification of inpatient team, Hospitalistor Care Manager when appropriate.
Coordinates, identifies and routes referrals thatrequire review to licensed Care Management staff who arranges outside physicianmedical review as appropriate.
Acts as a resource to other coordinators, staff andproviders by resolving issues and responding to requests in a timely andeffective manner.
Works with Patient Services regarding memberconcerns.
Processes referrals for inter-facility transfersusing pre-established guidelines.
Processes after-hours emergency/urgent carelogs/lists as needed.
Collects and prepares medical records for reviewwhen appropriate or as requested.
Assists with answering telephones and maintainingfiles, logs or other reports.
Uses, protects, and discloses HCP patients’protected health information (PHI) only in accordance with Health InsurancePortability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.
- High school diploma, G.E.D. or equivalent. Includes special certification required for specific jobs.
- Over 1 year and up to and including 3 years of experience.
3 to 5 years experience in a health care setting.
2 years referrals management or related experience.
KNOWLEDGE, SKILLS, ABILITIES:
Ability to type 30 wpm.
Knowledge of medical terminology and CPT/ICD-9 coding.
Excellent communication, organization and customer service skills.
Proven ability to problem-solve.
Strong attention to detail.
Ability to manage time effectively and work independently.
DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.
DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.
Primary Location CA-COSTA MESA - 92626
Req ID: 309411