Referral Coordinator

ChenMed • Lakeland North, WA

1d • $17 - $24 • Onsite

About The Position

We’re unique. You should be, too. We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. ESSENTIAL JOB FUNCTIONS:
The Care Coordinator will work with Care Center of Excellence, Physician Management Resources (PMR), market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management in ChenMed Medical Centers.
Primary Duties and Responsibilities
Daily review of approved and pended outpatient requests for PMR clients and ChenMed Markets.
Provide insights to the PMR team and Network Director and work with them to take action.
Facilitate a daily process to help redirect poorly supported requests by:
Providing feedback to Humana, Careplus, Wellcare and Coventry and working through daily authorization requests when information is missing.
Create process for managing requests when patients need to see the primary care provider by coordinating with primary care provider and Market leaders.
Enable a member of PMR network or clinical team to reach out to authorization requester when deemed necessary.
Other responsibilities may include:
Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible one dependent on market needs.
Travel as needed to PMR & ChenMed markets for training and support.

KNOWLEDGE, SKILLS AND ABILITIES:
Excellent analytical skills in order to solve the complex and logistical problems.
Strong communication and interpersonal skills, both written and verbal, as well as delivery skills for presentations and training.
Excellent organizational skills with ability to effectively manage multiple tasks and responsibilities.
Ability to deliver efficient, high quality results within tight deadlines.
Works well independently and within a team.
Excellent influencing and negotiation skills.
Ability to explain complicated financial terms and utilization data to physicians/staff.
Ability to understand, interpret and communicate all types of provider, regulatory contracts and utilization management data.
Fluent in English.

EDUCATION / SPECIALIZED KNOWLEDGE REQUIREMENTS:
Bachelor's degree.
3+ years Utilization Management and/or Provider Relations or Healthcare Analyst experience or similar background.
Advanced MS Word and Excel.
The ability to establish credibility quickly and the willingness to take a strong approach to leadership.
An understanding of the communities that ChenMed and PMR serves, including the complexities of Medicare programs to patients in the current healthcare marketplace.

PAY RANGE: $17.0 - $24.26 Hourly The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions. EMPLOYEE BENEFITS https://chenmed.makeityoursource.com/helpful-documents We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day. Current employees, if you want to apply to our internal career site, please click HERE Current Contingent Worker please see job aid HERE to apply #LI-Onsite Who We Are ChenMed is a family-owned, family-oriented organization committed to bringing superior health care to moderate-to-low-income seniors. Our vision To positively change American healthcare through primary care innovation for the neediest populations. Our mission To provide a convenient, patient-centered environment that fosters enduring relationships between doctors, staff and patients and delivers superior outcomes and a compassionate experience. We will create a healthcare system specifically for our patients' needs through dedicated doctors, a supportive team, and customized technology, and achieve value through scalable innovation, resourcefulness andaccountability. Our patient promise You are the reason we are here. Your coordinated healthcare and well-being is our focus. Like a member of our family, we will take care of you in good times and in times of need.

Requirements

• Excellent analytical skills in order to solve the complex and logistical problems.
• Strong communication and interpersonal skills, both written and verbal, as well as delivery skills for presentations and training.
• Excellent organizational skills with ability to effectively manage multiple tasks and responsibilities.
• Ability to deliver efficient, high quality results within tight deadlines.
• Works well independently and within a team.
• Excellent influencing and negotiation skills.
• Ability to explain complicated financial terms and utilization data to physicians/staff.
• Ability to understand, interpret and communicate all types of provider, regulatory contracts and utilization management data.
• Fluent in English.
• Bachelor's degree.
• 3+ years Utilization Management and/or Provider Relations or Healthcare Analyst experience or similar background.
• Advanced MS Word and Excel.
• The ability to establish credibility quickly and the willingness to take a strong approach to leadership.
• An understanding of the communities that ChenMed and PMR serves, including the complexities of Medicare programs to patients in the current healthcare marketplace.

Responsibilities

• Daily review of approved and pended outpatient requests for PMR clients and ChenMed Markets.
• Provide insights to the PMR team and Network Director and work with them to take action.
• Facilitate a daily process to help redirect poorly supported requests by:
• Providing feedback to Humana, Careplus, Wellcare and Coventry and working through daily authorization requests when information is missing.
• Create process for managing requests when patients need to see the primary care provider by coordinating with primary care provider and Market leaders.
• Enable a member of PMR network or clinical team to reach out to authorization requester when deemed necessary.
• Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible one dependent on market needs.
• Travel as needed to PMR & ChenMed markets for training and support.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees