SNF Coordinator

Regal Medical Group•Los Angeles, CA

3d•$25

About The Position

Responsibilities for this position include supporting the process that manages skilled nursing admissions, concurrent review, and discharge planning. The goal of the Skilled Nursing Facility Care Coordinator is to effectively support the SNF management process by assuring the right information is provided timely to the RMG & LCH administrative management team, Skill Nursing Physicians, and care managers. This includes ensuring that all necessary clerical functions from the time of admission through discharge, inclusive of required follow-up care are completed accurately and timely. Assist in facilitating skill nursing facility provision of required patient information and to support the SNF Case Manager. As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Requirements

High school graduate required; Associate in Arts degree preferred.
Knowledge of Healthcare and Managed Care preferred.
Typing 60 words per minute with accuracy.
Knowledge of computers, faxes, printers, and all other equipment.
Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point).
Ability to deal with responsibility in confidential matters.
Ability to work in a multi-task, high stress environment.
Ability to deal with problems involving several concrete variables in standardized situations.
Medical terminology, ICD9, and HCPC coding.
Good phone etiquette required.

Responsibilities

Census will be verified every morning with regards to in house status and a review will be requested.
Census reports should be printed daily before every rounds meeting.
Authorizations for Home Health/DME/Hospice/Follow up appointments will be done coordinating with Care Managers.
Request for authorizations will be given via fax/return phone calls.
Filing closed cases should be done in a timely manner.
Communicate to Medical Director or designee, immediately any admissions to non-core facilities.
Provide face sheet to Medical Director or designee, immediately upon receipt and eligibility check.
All new admissions are to be checked for Out of Area status.
Confirmation of admission status of all admissions will be obtained by 10 am for reporting at morning case rounds.
Assist SNF Care Managers with planning for discharge by generating authorizations and scheduling appointments for services needed at point of discharge.
Communicate with High Risk/Special Needs Program department any services identified upon discharge.
Support the safe, continuous delivery of medically necessary care and supportive ancillary services in the Skilled and transition to home care setting.
Identify network needs and report to management for potential contracting opportunities.
Review case statuses to ensure proper documentation and case closure. Work with assigned Care Managers to complete all documentation.
Communicate with supervisor on a daily basis regarding any potential issues.
Assist the Director of Case Management with the non-clinical functions of SNF Case Management Department.
Direct calls to the appropriate physicians.
Summarize all new overnight admission and inform the rest of the clinical team by 10:00am.
Open cases for admission accurately and timely for assigned Skilled Nursing Facilities.
Communicate daily with Care Management Nurses to assist with eligibility and benefits.
Checks eligibility and benefits for all admissions.
Process all ambulatory authorizations for designated hospital at the direction of the C.M. Nurse.
Process ancillary discharge authorizations for members as needed and fax to appropriate vendor.
Fax facility documentation (H&P and D/C summary) to PCPs for each patient.
Prepares appropriate denial letter at the direction of the C.M. Nurse and or based on standard SNF guidelines/benefit.
Maintains confidentiality of all patients and medical/clinical information.
Monitoring incoming fax server and flag each fax with the standard color system to ensure proper routing of data; reporting any discrepancies to management.
Performs other duties as directed by management.