Referral Coordinator - Pcp

Tri-City Medical Center•Oceanside, CA

About The Position

Tri-City Healthcare District has been serving the North County region for almost 60 years and remains committed to providing high quality healthcare and community services for every individual we encounter regardless of race, color, ethnicity, gender, sexual orientation, disability or socioeconomic status. Our mission is to advance the health and wellness of the community we serve. In order to achieve our mission, we see, hear and listen to our front line healthcare workers, employees, medical staff and all community stakeholders in order to understand and meet our community’s needs. Position Summary : The Referral Coordinator proactively identifies, coordinates, and verifies referrals as required by insurance companies dependent upon the plan coverage for all patients. The Referral Coordinator is responsible for facilitating patient’s transition from an acute care setting and/or inpatient services post discharge. The Referral Coordinator is also responsible for the development and maintenance of IPA regulations and compliance. Additional specialty projects such as chart requests, assists with logistical and /or clerical problem resolution related to patient’s medical record, authorization and billing issues. Major Position Responsibilities : The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization. Maintains a safe, clean working environment, including unit based safety and infection control requirements. Schedule, track, problem solve and coordinate referrals with outside specialists and patients. Collaborates with interdisciplinary departments to identify potential candidates for admission. Serves as liaison between physicians, staff and payers to promote referral development activities. Coordinates and identifies patient care needs with Home Health referrals. Acts as liaison between agency and acute care staff. Completes all necessary documentation for admission/statistical reporting. Provides information regarding current diagnosis and obtains orders for care and home equipment needs, caretaker status and other factors impacting home care or hospice to appropriate team members. Obtains authorization from payers as required. Obtains, delivers and secures required medical documents. Meets referral goals to grow and sustain census. Meets IPA referral regulations for compliance. Fosters and manages day to day relationships with patients, physicians, nurses and allied health professionals. Follows and monitors status of patients who have been re-admitted to the hospital or SNF’s so patient care is resumed per Physician’s orders. Consistently communicate patient’s status with Home Health and Hospital case managers as well as SNF discharge planners. Interacts with patients, family members and other points of interest to ensure overall satisfaction. Performs other duties as assigned by the department supervisor or above.

Requirements

Minimum of 2 years’ experience processing referrals both HMO, PPO/Tricare required.
Understanding and compliance with IPA requirements and Home Health and/or Hospice policies and practices, required.
Intermediate to advanced medical terminology required.
Intermediate computer skills (Outlook, WORD, PowerPoint), required.
Ability to work in a dynamic healthcare organization in both a team and independent environment required
High School diploma or equivalent, required.
Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.
To protect the health of patients and staff, and to comply with the new State of California mandates, all job offers are contingent on the successful engagement in the TCMC COVID-19 vaccination program (fully vaccinated with documented proof or approved exception/deferral.)

Responsibilities

Maintains a safe, clean working environment, including unit based safety and infection control requirements.
Schedule, track, problem solve and coordinate referrals with outside specialists and patients.
Collaborates with interdisciplinary departments to identify potential candidates for admission.
Serves as liaison between physicians, staff and payers to promote referral development activities.
Coordinates and identifies patient care needs with Home Health referrals.
Acts as liaison between agency and acute care staff.
Completes all necessary documentation for admission/statistical reporting.
Provides information regarding current diagnosis and obtains orders for care and home equipment needs, caretaker status and other factors impacting home care or hospice to appropriate team members.
Obtains authorization from payers as required.
Obtains, delivers and secures required medical documents.
Meets referral goals to grow and sustain census.
Meets IPA referral regulations for compliance.
Fosters and manages day to day relationships with patients, physicians, nurses and allied health professionals.
Follows and monitors status of patients who have been re-admitted to the hospital or SNF’s so patient care is resumed per Physician’s orders.
Consistently communicate patient’s status with Home Health and Hospital case managers as well as SNF discharge planners.
Interacts with patients, family members and other points of interest to ensure overall satisfaction.
Performs other duties as assigned by the department supervisor or above.