DaVita Care Coordinator- Torrance in TORRANCE, California

Care Coordinator- Torrance

Description

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 September 30,2016 DaVita Medical Group (formerly HealthCare Partners) provided integrated care management for approximately 750,000 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.

Overview:

Responsible for maintaining and managing the internal and external utilization processes in a 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 communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.

  • Performs effective prospective and concurrent review of requested services according to established guidelines and timeframes.

  • Documents members’ service benefits by contacting the appropriate health plans as needed.

  • Directs providers/members to contracted provider network and facilities.

  • Processes appropriate authorizations for HMO/PPO clients as specified in the HCP procedures.

  • Prints and mails authorizations to providers, patients, HMOs and facilities as needed.

  • Assists and monitors in the processing of referrals. Enters, updates and closes referrals daily while assuring that appropriate internal/external referral providers are utilized, members are eligible and have benefits coverage, correct CPT/ICD-9 codes have been entered, accurate records of all dates and other required fields are entered, supporting clinical data for the referrals is entered, and all urgent referrals are processed within the designated timeframe.

  • Processes referrals for durable medical equipment and coordinates home health services according to established policies, procedures and guidelines.

  • Processes elective surgical requests including the coordination of surgery dates and notification of inpatient team, Hospitalist or Care Manager when appropriate.

  • Coordinates, identifies and routes referrals that require review to licensed Care Management staff who arranges outside physician medical review as appropriate.

  • Acts as a resource to other coordinators, staff and providers by resolving issues and responding to requests in a timely and effective manner.

  • Works with Patient Services regarding member concerns.

  • Processes referrals for inter-facility transfers using pre-established guidelines.

  • Processes after-hours emergency/urgent care logs/lists as needed.

  • Collects and prepares medical records for review when appropriate or as requested.

  • Assists with answering telephones and maintaining files, logs or other reports.

  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability 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

  • Bilingualpreferred.

Primary Location CA-TORRANCE - 90503

Req ID: 304333