Case Manager Coordinator

We have an immediate need for a Case Manager Coordinator working for a very large medical group IPA. 

 

POSITION SUMMARY
Under the supervision of the UM Clinical Manager and Director, UM, the Case Management Coordinator is responsible for providing support for the Case Managers with inpatient and discharge planning coordination and coordination of care for High-Risk members.


ESSENTIAL DUTIES AND RESPONSIBILITIES
" Assist Case Managers in coordinating services needed for inpatient admissions and/or discharge planning.
" Accurately identify services La Vida is at financial risk for.
" Accurate data entry of inpatient admissions and outpatient authorizations.
" Identify services requiring benefit verification and accurately document information based on dept. Policy & Procedures.
" Telephone hospitals for admission and discharge dates, including additional information requested by Case Managers.
" Assist in discharge planning, appointment scheduling, and transportation needs of members.
" Run daily census or other reports, as requested.
" Request records, as indicated from facilities or vendors.
" Accurately identifies contracted verses non-contracted provider requests and capitated providers and hospitals.
" Understands and exhibits knowledge of UM delegation status by obtaining Health Plan authorization on all services that require prior authorization.
" Accurately identifies potential CCS cases and communicates with CCS for authorizations.
" Ensures compliance with department & regulatory confidentiality standards for member data and clinical information.
" Other duties, as assigned.


QUALIFICATIONS 


EDUCATION: Requires a high diploma or GED Equivalent.
EXPERIENCE: At least 2 years experience in a managed care environment or equivalent setting. 
Experience in processing referrals, use of medical criteria and financial risk arrangements.
ABILITIES: Knowledge of Medi-cal, Medicare, Healthy Families, Commercial, and Senior plans and benefits.
Knowledge of CPT and ICD-9 Coding and medical terminology, Policies and procedures etc. 
Ability to analyze problems and formulate plans, solutions, and course of action.