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.
We currently have an opening for a Medical Management Coordinator .
Medical Management Coordinator role working under the direction of lead inpatient case manager and/or inpatient case management leadership team:
1.Reconcile with daily census report. Prepare updates for Lead IP CM to make the morning assignments. Reconciling the daily census report includes calling facilities to verify patient's presence, confirm new admissions and discharges, and running new morning census report.
2.Review daily census report for observation cases nearing or passed two midnight stay at the hospital. Notify lead IPCM and proceed with next steps as instructed.
3.Based on inpatient morning assignment, the MM coordinators update the REA queue with the assigned IP CM.
4.Call all facilities that Regal does not have EMR access to request faxed clinical documentation for all members in house.
5.Check all OON/OOA cases still in house and forward list to Lead CM and RMD.
6.Attend RMD/IP rounds note changes in inpatient status such as correct level of care, correct diagnosis, change patient status, and discharge planning.
7.After rounds, review changes noted in rounds with Manager and/or Lead IP CM, and start working on pending discharge needs.
8.CREATE DPL FOR POTENTIAL DISCHARGE THAT DAY.
9.Based on DPL, MM coordinators make sure:
a) dc orders for home health, DME, transportation are forwarded to IP coordinators,
b) follow-up on prior authorizations for medications until resolved,
c) expedite completion of discharge planning before 5 pm.
10. Review Error reports. Assist in resolution of authorization issues including but not limited to "Provider Not Listed" errors.
11. Assist in finalization of authorizations in queue under the direction of case management team.
12. Review case management audit results, authorization compliance reports and bed day error reports. Assist in resolution of discrepancies and errors under the direction of lead IPCM or leadership team.
13. Assist case managers in completing referral forms such as Social Work, Patient Quality Improvement, Patient Advocacy, Behavioral Health, Chemical Dependency to optimize continuum of care.
14. Assist case managers to preparing SNF referral package. If SPT not available, MM coordinator will assist in faxing bed inquiries to skilled nursing or other types of facilities for discharge disposition under the direction of case management team.
15. Assist case managers to preparing outpatient dialysis referral package, including obtaining dialysis chair time.
16. Assist in completion of different types of letters, including denial, aberrancy, carve out, and DND letters used in case management operations under the direction of the Manager. Upload into REA and log all letter sent. Update REA supplemental page with aberrancy/ denial letter information. Accountable for the DND process per CMS requirements.
17. Upload received clinical information into REA.
18. Assist case management leadership team in general clerical support as needed.
1.Accurate daily census is a priority every morning to ensure correct patient and admission information for daily rounds.
2.Maintain accurate authorizations to ensure proper utilization of resources and prevent future claims review due to incorrect authorizations.
3.Inpatient authorizations steer data for bed days, which is one of the most important metrics in Medical Management.
4.Accurate internal work queue list for inpatient case management team.
5.Authorizations are finalized timely within TAT expectations.
6.Discrepancies in case management audit results and bed day error reports are corrected.
7.Inpatient utilization meets criteria/guidelines from CMS, MCG and health plan for hospital admissions, level of care, length of stay and medical necessity for ancillary services including durable medical equipment.
8.Expedited process for sending referral requests to inpatient or outpatient coordinators.
9.Hand-off information from inpatient case manager to after-hours team as well as inpatient coordinators is critical in care coordination.
10. Prior-authorization from insurance company for new medication is obtained prior to patient discharge.
11. Possible hurdles in filling new medications for patients are identified and cleared prior to discharge.
12. Medication adherence is crucial in prevention of hospital readmission.
13. Timely patient transfer from acute hospital to skilled nursing facility is an important aspect affecting length of stay and consequently bed days.
14. Accurate and timely communication with hospitals regarding bed day aberrancies, service/care issues, post-stabilization notification, as well as financial responsibilities for OOA/OON admissions, psychiatric admissions, hospice revocations or discharges, Medicare prime, and refusals to discharge or transfer.
15. Aberrancy is tracked for quality reviews.
16. DND letters should be tracked and logged as required by health plans.
17. PQI reports are important in quality improvement.
18. Exact and timely compensation for staff during their on-call/after-hours and weekend duties are crucial elements in payroll and human resource management.
Education and/or Experience:
1.High school graduate required; Associate in Arts degree preferred.
2.Knowledge of Healthcare and Managed Care preferred.
3.Typing 60 words per minutes with accuracy.
4.Knowledge of computers, faxes, printers and all other equipment.
5.Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
6.Ability to deal with responsibility with confidential matters.
7.Ability to work in a multi-task, high stress environment.
We offer a full benefits package which includes employer paid medical, pharmacy and dental benefits. We offer a generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for our clinical staff.
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.