DaVita Care Coordinator- Costa Mesa in COSTA MESA, California

Care Coordinator- Costa Mesa

Description

DaVitaMedical Group manages and operates medical groups and affiliated physiciannetworks in California, Nevada, New Mexico, Florida, Colorado and Washington inits pursuit to deliver excellent-quality health care in a dignified andcompassionate manner. As of September 30,2016 DaVita Medical Group (formerlyHealthCare Partners) provided integrated care management for approximately750,000 patients. DaVita Medical Group’s leadership development initiatives andsocial responsibility efforts have been recognized by Fortune, ModernHealthcare, Newsweek and WorldBlu.

We arecommitted to bringing the benefits of coordinated care to our patients and totaking a leading role in the transformation of the national healthcare deliverysystem to assure quality, access, and affordable care for all.

Ifyou're looking to make a difference with a large, financially stable,well-recognized medical group, DaVita Medical Group may be the employer foryou.

Overview:

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.

Essential Functions:

  • 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.

Qualifications

EDUCATION :

  • High school diploma, G.E.D. or equivalent. Includes special certification required forspecific jobs.

EXPERIENCE :

Minimum:

  • Over 1 year and up to and including 3 years ofexperience.

Preferred:

  • 3 to 5 years experience in a health care setting.

  • 2 years referrals management or related experience.

KNOWLEDGE, SKILLS, ABILITIES:

  • Computer literate.

  • Ability to type 30 wpm.

  • Knowledge of medical terminology and CPT/ICD-9coding.

  • Excellent communication, organization and customerservice skills.

  • Proven ability to problem-solve.

  • Strong attention to detail.

  • Ability to manage time effectively and workindependently.

  • Bilingual preferred.

Primary Location CA-COSTA MESA - 92626

Req ID: 301609