Position Summary:
The Outpatient Coordinator Lead is responsible for navigating the care management across the continuum of care of the member from acute to outpatient case management. The Outpatient Coordinator Lead's role is to incorporate administrative job functions to provide optimal care and coordination of care for members. The Outpatient Coordinator Lead will assist the case management team in care coordination during the transition of care levels. The Outpatient Coordinator Lead will be responsible for developing relationships with members and providing support, encouragement, and health education. Responsibilities include but are not limited to assisting in scheduling medical appointments, durable medical equipment, home health, eligibility/benefit verification, requesting medical records, data entry, review of medical management reports, and referral processing as needed. The Outpatient Coordinator Lead will work closely with nurse, doctor, and management staff to coordinate care for members delegated or assigned. The Outpatient Coordinator Lead is responsible for coordinating non-clinical tasks to support the delivery of care coordination to members who meet case management criteria. The Outpatient Coordinator Lead promptly, efficiently and accurately processes referrals as needed. Facilitating the right care at the right time in the right setting. Maintain turnaround time compliance in all aspects of the referral processing as part of care coordination with members primary care physician/specialist. Promote the quality and cost effectiveness of medical care through adherence to UM Policy and procedure. The Outpatient Coordinator Lead will maintain and complete work within due dates/timelines based on regulatory compliance expectations. Expected to promote excellent team work by collaborating in process improvement efforts. The Outpatient Coordinator Lead is responsible for conducting calls to members to engage into case management programs. Collaboration with doctor's office for referral processing requests and or expediting referrals. Participation in quality audits for the coordinators as well as attendance of Health Plan Audits. Creation of job aids and tools for the department. Serves as preceptor in the team. Collaborates with Leadership in process improvement.
Essential Duties and Responsibilities include the following:.
- Ability to remain positive in a fast paced environment
- Documents clearly and concisely in members file using directed documentation style
- Ability to time manage in a high work environment
- Follow process protocols efficiently and report any areas of process improvement to leadership
- Adaptability to consistent process changes
- Ability to remain organized throughout the day to allow quality and productivity.
- Ability to maintain, read, respond to all outlook communication in a timely manner.
- Maintenance of Fax Servers as delegated
- Able to use system resources to increase productivity and organization
- Ability to recognize and communicate when assistance is needed and ability to assist others when time is available but also when instructed to do so.
- Adherence to timekeeping policy expectations
- Welcome constructive criticism as an opportunity to learn and grow
- Communicate in a clear and concise manner
- Follow best practice email etiquette with HIPAA best practices
- Ability to use chain of command when escalating barriers
- Coming up with innovative solutions and proposals to leadership
- Ability to use critical thinking and problem solving
- Demonstrate integrity and character in the face of overwhelming challenges
- Ability to take responsibility over member and tasks and resolving issues timely
- Responsible for contacting members to provide necessary wellness education to improve self-management skills and enhance patient provider communication.
- Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of involvement they need.
- Returns phone calls to customers and follows up with requests in a timely manner.
- Ability to maintain high call volume; incoming and outgoing calls.
- Assists other staff and supports the team approach.
- Demonstrates honesty and integrity in everyday activities.
- Protects privacy for both patients and employees; ensures all personal health information is kept confidential i.e., (sensitive papers, charts, and reports are not in view of the public).
- Recognizes when an error has been made and immediately reports to appropriate management staff.
- Participates in “service recovery” through follow-up with an upset customer, gathering information, and demonstrates empathy.
- Functions as liaison between care managers, patients, physicians, and other healthcare providers.
- Assists team with coordination of services such as home health, DME, physician appointments, specialist appointments, and transportation.
- Identifies members from daily discharged list that have been admitted to a facility and coordinate the discharge plan. (as applicable)
- Requests admission and discharge records for coordination of care. (as applicable)
- Notifies providers of patients' admission and health status and verifies patient follows up post discharge. (as applicable)
- Follows post discharged members from acute and SNF settings and assist in implementing discharge plans. (as applicable)
- Checks benefits and identify member's program eligibility.
- Ability to maintain system processing as directed.
- Processes referrals based on Discharge Plans and orders sent by Case Manager and or Physician.
- Maintains turnaround time compliance in all aspects of the referral process and OPCM regulatory compliance.
- Demonstrates outstanding customer service skills with a can-do attitude.
- Consults other departments as appropriate to provide services to member's needs.
- Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
- Maintains all reference material that is provided by the supervisor, manager or director.
- Knows and follows the Employee Handbook policies and procedures.
- Maintaining Individual Excel Logs with accurate data, in a timely manner. Responsible for saving Individual Excel Logs in a consistent basis to allow real time review of data in the log.
- Participate in on-going training and in-services as needed.
- Excellent documentation skills.
- Ability to work independently.
- Able to be flexible and adapt to rapidly changing work environment.
- Expected to be dependable and a trusted part of the team by proactively communicating with peers and leadership in a collaborative manner.
- Ability to keep motivated through fast paced environment and escalating to leadership as needed.
- Ability to remain focused on achieving delegated assignment.
- Expected to use directed tools and templates to perform delegated job duties.
- Use of Language Line provided to communicate with non-English speaking members.
- Able to process referrals as needed as part of care coordinator for members
- Participate as preceptor in occasion as scheduled by Lead/management
- Delegated UTC and Declined ICT Prep template completions
- Crossed trained in phase 1 and phase 2 process and 2 or more lines of business
- Able to work PDC and DCP (as applicable to team assignment)
- Able to assist PDC and OPCM (as applicable to team assignment)
- Present a topic during meeting (at least 1 time in a year)
- Independently takes initiative in organizing and increasing work pace in their own case load to allow for extra time to assist peers.
- Demonstrates the ability to follow through with request
- Assist level I outpatient coordinator as needed in complex calls
- Ability to review case and identify and provide constructive feedback to peers (CC/CMs) and inform leadership of feedback.
- Expected to time manage and able to complete their work and assist others
- Expect to serve and volunteer for Overtime when team needs to meet deadlines
- HR Courses/Training from Employee Services Complete 3 out of 5 identified trainings:
- Identifying & Solving Problems
- Customer Service
- Making Decisions, Weighing Risk
- Giving Clear Information
- Time Management Effectiveness Profile
- Praxis/IRR – MediCal, UM, non-clinical pertinent trainings as delegated by management
- Action driven to results of their work
- Training as needed for CCs and CMs
- Assigned mentor and review of outpatient coordinator I & II individual logs for accuracy
- Proposal of process improvement (at least 2 -5 in a year)
- New Hire Preceptor/Shadowing
- Requesting HLP portal access set up for new hire
- New Hire Quality Audit completion to be completed within 40 days of new hire start date
- ADHOC Health Plan Audit (Listen-in Audits)
- Assist in Outpatient Coordinator Audits and sit with Lead(s) to provide the results
- UM Referral TAT Knowledge/Processing. (IRR Prior Authorization Testing)
- Job Aid Creation & Maintenance
- Data Analyst assistance in HLP reporting as needed
- Delegated UTC, Declined and Engaged ICT Prep template completions
- Serve as presenter in during monthly meeting for approved topic
- Scheduling Fax Server Rotation
- Rotation of monthly review of the P drive for any NDN & MLI version updates
- Cisco Hunt Group Voicemail rotation
- Performs other duties as directed by management.
The pay range for this position at commencement of employment is expected to be between $27 - $28 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
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.
Full Time Position Benefits:
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
- Employer-paid comprehensive medical, pharmacy, and dental for employees
- Vision insurance
- Zero co-payments for employed physician office visits
- Flexible Spending Account (FSA)
- Employer-Paid Life Insurance
- Employee Assistance Program (EAP)
- Behavioral Health Services
Savings and Retirement:
- 401k Retirement Savings Plan
- Income Protection Insurance
Other Benefits:
- Vacation Time
- Company celebrations
- Employee Assistance Program
- Employee Referral Bonus
- Tuition Reimbursement
- License Renewal CEU Cost Reimbursement Program
- Business-casual working environment
- Sick days
- Paid holidays
- Mileage
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Requirements:
Education and/or Experience:
- Must have 3+ year in the Outpatient Coordinator II role
- Annual Performance review of exceeding expectation (3.00 or above) in 2 or more years in a row
- High school graduate required
- 6 years of healthcare setting and Managed Care experience preferred
- 6 years of customer service experience preferred
- Bilingual Preferred
- Medical Assistant certification, Associates or Bachelor preferred
- Strong analytical skills with the ability to organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy required
- Ability to work independently while collaborating in meeting team goals
- Typing 40 words per minute
- Data Entry accuracy
- Attention to Detail
- Availability to work consistently in scheduled time as well as Overtime as needed
- Mastery level of operating computers, faxes, printers and all other equipment
- Mastery level in MS office programs in intermediate or above level: Excel, Word, Power Point, and Outlook
- Ability to follow HIPAA confidentiality policy and procedures
- Ability to work in a fast pace environment
- Flexible and adapts to process changes
- Medical terminology, ICD10, and HCPC coding preferred
- Proficient conflict resolution experience
- Proficient in critical thinking and problem solving
- Ability to communicate clearly
- Completion of courses/training as described in Essential Duties
Compensation: 27-28