IEHP
IEHP
1 001 – 5 000 Қызметкерлер
КонсалтингЛогистикаСақтандыру
IEHP — Риверсайд және Сан-Бернардино округтеріндегі табысы төмен адамдар мен отбасыларға қызмет көрсететін өңірлік денсаулық сақтау жоспары. 1995 жылы құрылған ұйым Medi-Cal, DualChoice және Covered California сияқты бағдарламалар арқылы қамтуды қамтамасыз етеді және мүшелерін медициналық қызметтермен байланыстыру үшін жергілікті дәрігерлермен әрі денсаулық сақтау мекемелерімен жұмыс істейді. Қауымдастыққа бағытталған бұл тәсіл психикалық денсаулықты қолдауды, дене шынықтыру бағдарламаларын және салауатты өмір салты бойынша білім беруді де қамтиды.

Non-Routine Placement Coordinator

Coordinate health plan referrals, eligibility checks, and member discharges in a hybrid role at IEHP. Support nurses, providers, and care teams with accurate medical management records.

Сипаттама

  • Keep member face sheets accurate and up to date with current demographic details.
  • Monitor RightFax, the EDI interface, and medical management system to process incoming cases promptly.
  • Review daily census reports and remove duplicate or unnecessary admissions.
  • Confirm member eligibility and route authorizations to the appropriate NRP nurse using the Far tool.
  • File reviews and orders in the medical management system for NRP nurse review.
  • Confirm member discharge dates through calls, electronic medical record reviews, or submitted memos.
  • Process program referrals and member discharges promptly.
  • Request additional medical information from providers by phone, fax, or email.
  • Coordinate with providers and facilities on program referrals, orders, and clinical reviews.
  • Support NRP nurses with care coordination for members who have care management needs.
  • Arrange hospital follow-up appointments and share appointment details with members.
  • Record call interactions in the medical management system.
  • Work with internal teams to address member care issues and consult Hospital & Ancillary Department leaders.
  • Help identify HEDIS care gaps and conduct outreach to members.
  • Maintain documentation in line with regulatory and accreditation standards.
  • Contribute to workflow improvements and departmental initiatives.
  • Handle other duties that support health plan operations and department needs.

Талаптар

  • At least two years of data entry experience in a customer service focused environment.
  • Data entry experience in an HMO or managed care setting is preferred.
  • Utilization Management experience is preferred.
  • High school diploma or GED required.
  • Knowledge of ICD-10 and CPT codes.
  • Knowledge of utilization management in a health care delivery setting is preferred.
  • Proficiency with computer applications, including word processing, databases, and spreadsheets.
  • Strong customer service skills.
  • Ability to meet productivity and accuracy performance standards.
  • Ability to represent the organization in a friendly, professional manner when answering calls.
  • Ability to support a positive, collaborative team environment.
  • Ability to attend scheduled meetings.

Артықшылықтар

  • Competitive salary.
  • On-site fitness center with modern equipment.
  • Medical, dental, and vision insurance.
  • Life, short-term disability, and long-term disability options.
  • Career growth and professional development opportunities.
  • Wellness programs supporting work-life balance.
  • Health care and childcare Flexible Spending Accounts.
  • CalPERS retirement plan.
  • 457(b) plan with an employer contribution match.
  • Employer-paid life insurance.
  • Pet care insurance.

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