Supervisor, Care Transition Coordinator - 26-37

PriMed Management Consulting•San Ramon, CA

6d•$87,000 - $113,000

About The Position

This position performs a liaison function between clinicians at hospitals, members/patients, providers and nursing facilities and HPMG staff in the HRM, Network Management and related departments. The Supervisor oversees the team of Coordinators. This team supports the concurrent review nurses as they facilitate timely hospital and nursing facility discharges by serving as a point of contact for coordination of inpatient member issues. Receives, and either resolves or routes, requests for assistance with services such as: appointment making, IHMM referral (home physician visiting), inpatient hospital and skilled nursing facility authorization processing, authorizations for post discharge services including home health, equipment and transfers, high risk member information, case management referrals, general questions and other issue/questions as assigned. The Supervisor monitors and tracks issues received to assure timely resolution and feedback communication to referral source. The Supervisor will participate in audits, training, developing workflows and supporting the HRM inpatient team.

Requirements

3+ years’ managed care experience preferred
Medical terminology required.
Experience using ICD9/10 CPT coding preferred
Computer Experience: proficiency with routine applications including Microsoft Word and Excel and or web-based application
Ability to coordinate effectively with a variety of customers including: members, providers, hospital and office staff, health plans, internal departments, community resources, and peers.
Ability to work independently as well as in team environment.
Ability to interface with all levels of management.
Demonstrated project coordination skills.
Multi-tasking and ability to prioritize and problem solve through critical thinking.
Ability to contribute to cross-functional work groups both as a leader and participant.
Ability to meet strict timeframes.

Responsibilities

Assist nursing staff in obtaining clinical information from facilities and summarizing information for continuing nursing facility stays, processing letters as directed by the CCR/TOC nurses and processing authorizations which require only administrative level of review.
Serve as the contact to receive and process authorizations that are needed to support timely discharge from the hospital or nursing facilities reviews benefit and Health Plan guidelines for appropriateness. Reviews guidelines to make sure only contracted vendors are used.
Ability to work independently with self-initiative and discipline
Collaborates with the interdisciplinary team to assist in the implementation of the identified discharge plan.
Research for coverage or benefit questions and contract status.
Demonstrated interpersonal communication skills; ie: motivational interviewing
Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.
Coordinate internal and external resources for the individual member.
Attends meetings as needed.
Assist TOC/CCR nurses with discharge needs identified by clinical staff.
Obtain medical records/clinical information and discharge dates as needed
Process select authorizations not requiring nurse or Physician Advisor review.
Utilize HPMG resources such as guidelines and SharePoint.
Route authorizations as directed.
Oversee denial letters
Benefit verification with health plans.
Will require travel to office sites (aside from home office location) as needed for leadership meetings/staff training.
Participate in training of new employees and new processes/workflows.
Assist supervisors with ongoing/annual audits of staff and identify areas that require additional staff education