Coordinator - Integrated Transitional Care

The Coordinator - Integrated Transitional Care is a fast-paced position responsible for the timely processing of authorization requests, verifying member eligibility, and obtaining additional information as requested by the Integrated Transitional Care Nurse. Collaborate with team members regarding member care issues and consult with the Integrated Transitional Care Nurse or management to help ensure the appropriate treatment plan is followed thoroughly and promptly.

Location: Hybrid work schedule. Monday and Friday remote; Tuesday through Thursday onsite in Rancho Cucamonga, CA.

Description:
The Coordinator - Integrated Transitional Care is a fast-paced position responsible for the timely processing of authorization requests, verifying member eligibility, and obtaining additional information as requested by the Integrated Transitional Care Nurse.

This role requires strong organizational and multitasking skills, along with working knowledge of ICD-10, CPT coding, and medical terminology. The Coordinator will work as an extension of the clinical team to complete non-clinical functions as assigned.
For bilingual positions only, candidates must be proficient in English and Spanish and will be required to complete and pass a language proficiency assessment.

What You Will Do:

• Monitor the RightFax server, EDI interface, and medical management system intake to ensure all face sheets are processed in a timely manner.
• Ensure hard-copy and electronic face sheets are complete and accurate and reflect current member demographic information.
• Review the daily census report to identify and eliminate duplicates or admissions received from contracted and non-contracted facilities that are not required by the health plan.
• Cover Cisco ACD Queue telephone lines and phone queues.
• Verify member eligibility and assign authorizations to the appropriate Integrated Transitional Care Nurse based on the FAR tool.
• Attach reviews and orders to the medical management system for review by the Integrated Transitional Care Nurse.
• Review and approve service requests within the Coordinator scope as outlined in the Utilization Management Guide approved by the Utilization Management Subcommittee.
• Obtain member discharge dates through daily calls, electronic medical records, or memo submissions to contracted and non-contracted facilities.
• Meet performance standards for productivity, accuracy, and timely processing of inpatient authorizations, inpatient service requests, and discharges.
• Assist with the referral process by contacting providers by phone, fax, or email to request additional medical information as needed.
• Schedule hospital follow-up appointments for members when needed, provide appointment information to the member, and document the call in the medical management system.
• Confirm that members receive Home Health and/or Durable Medical Equipment (DME) items as ordered and document outreach in the medical management system.
• Process and coordinate disenrollment and transportation as needed.
• Provide friendly and professional service while answering calls for the Utilization Management Department.
• Communicate with providers and facilities, in consultation with the Integrated Transitional Care Nurse, regarding authorizations, orders, and clinical reviews.
• Assist the Integrated Transitional Care Nurse with the management and coordination of care for members identified with care management conditions.
• Collaborate with team members regarding member care issues and consult with the Integrated Transitional Care Nurse or management to help ensure the appropriate treatment plan is followed thoroughly and promptly.
• Assist with identifying HEDIS gaps and conducting member outreach to address those gaps.
• Ensure documentation is accurate and compliant with regulatory requirements and accreditation standards.
• Provide support to management or the Inpatient Clinical Team as requested.
• Attend meetings as scheduled.
• Promote a positive and collaborative working environment within the Care Management Team.

You Will Be Successful If:

• You have strong organizational and multitasking skills.
• You have working knowledge of ICD-10 and CPT codes.
• You are skilled with computer applications, including word processing, databases, and spreadsheets.
• You have strong customer service skills.
• You can work effectively in a fast-paced healthcare environment.
• You can maintain accurate documentation and meet productivity and processing standards.

What You Will Bring:

• High School Diploma or GED.
• Minimum of two (2) years of experience as a data entry specialist.
• Experience in a managed care or physician office setting.
• Valid California Driver's License.
• Knowledge of ICD-10 and CPT codes.
• Computer skills, including word processing, database, and spreadsheet applications.
• Good customer service skills.
• For bilingual positions only: English/Spanish written and verbal skills and successful completion of the required language proficiency assessment.

Preferred Qualifications:

• Data entry specialist experience in an HMO or Managed Care setting.
• Utilization Management experience.
• Knowledge of utilization management in a healthcare delivery setting.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That s Impresiv!