DaVita Care Management Coordinator 3 - Long Beach in TORRANCE, California

Care Management Coordinator 3 - Long Beach

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 ensuring the timely and accurate processing of high-volume internal andexternal referrals. Performs complexinitial review consistent with HealthCare Partners’ (HCP) policies. Maintains acute hospital and SNF bed day datato ensure the integrity of the monthly bed day report.

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 complex triage of high-volume referralsand channels to the appropriate Care Managers.

  • Decreases the workload of LVN/RN, Care Manager byauthorizing requests for service following the preferred provider and/orextended provider listings to obtain difficult benefit interpretations fromhealth plans for Care Management Coordinators 1 and 2 and LVN/RN, Care Manager.

  • Performs high-level critical thinking forre-direction of inappropriate referrals.

  • Assists Supervisor in mentoring and overseeing dataentry for IRR and ensuring adherence to PPL, PRL and IMCS processes.

  • Interfaces with acute care facilities and skillednursing facilities with multiple contractual agreements to ensure properinpatient/outpatient authorizations.

  • Utilizes applicable facility-based software toobtain admission information daily to verify eligibility and benefits and toensure containment of costs.

  • Informs RN, Care Manager of admission, eligibilityand benefits problems.

  • Monitors admission of patients from otherIPA/regions and notifies inpatient or OOA Care Manager of admission so thathospitalist can be assigned to care of patient.

  • Maintains accurate daily census, admission and dischargedata for review by Regional Manager to ensure appropriate use of CareManagement staffing.

  • Monitors length of stay for exhaustion of SNFbenefits.

  • Updates day surgery authorizations as hospitalrecords are received.

  • Interfaces with hospital Business Office to obtainretro reviews on patients inaccurately coded upon admission or for hardcopyemergency room admission authorizations.

  • Assists Regional Manager with Bed Day Error Reportby communicating with Care Manager to assure timely level of care and D/C dataentry.

  • Monitors HCP daily census to check for errors indata entry.

  • Enters into IDX all DME and HH requests for servicefrom acute and SNF Care Management.

  • Facilitates exchange of information between alllevels of Care Managers to ensure continuity of care.

  • Assists Manager, Care Management in communicationswith Care Managers.

  • Works on special projects for Manager, CareManagement.

  • 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 3 years and up to and including 5 years ofexperience.

Preferred:

  • 4 to 6 years in healthcare setting (doctor’soffice, acute care setting).

  • 4 to 5 years referrals management or relatedexperience.

KNOWLEDGE, SKILLS, ABILITIES:

  • Computer literate.

  • Ability to type 45 wpm.

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

  • Knowledge of IPA/group internal processes andcontractual agreements.

  • Working knowledge of HMO/managed care/health plan.

  • Ability to adhere to multi-contract language.

  • Excellent communication, organization and customerservice skills.

  • Detail-oriented.

Primary Location CA-TORRANCE - 90504

Req ID: 303067