This position is responsible for scheduling and coordinating off-site specialist appointments for urgent routine and follow-up appointments in accordance with the approved authorizations, scheduling and wait time objectives. Responsible for providing clear communication regarding future and past appointments to the PCP and IDT team. This position works closely with members of the IDT team to coordinate services and advocate for participants specialty needs.
Review approved authorization requests for accuracy. Communicate and coordinate with the Utilization Management department to modify authorizations, extend expiration dates, and modify CPT codes as needed.
Schedule all approved authorizations to assure corresponding appointments are scheduled within the P&P guidelines. Work in collaboration with IDT members, Primary Care Providers and nursing to ensure clear communication and coordination of care regarding all in-house and outside appointment. Focusing on participant communication, adherence and proper preparation for all appointments Prepare appointment cards and documents.
Print and fax approved authorizations to respective specialty medical offices as needed. 5. Knowledgeable and able to effectively and efficiently access required information systems to schedule and completed authorizations and to support the reporting requirements. Collaborate with Transportation Coordinator or designee to schedule participant transportation for offsite medical specialty appointments.
Collaborate with Care Center /Medical Escort supervisor for the coordination of escort coverage for offsite medical specialty appointments for participants that require support. Conduct daily and weekly confirmations of specialty medical appointments with the specialist medical offices and rescheduling them as instructed . Work in collaboration with Health Information team to obtain participant medical records as needed for upcoming offsite specialty medical appointments. Prepare and organize all specialty appointments requiring medical notes, labs, radiology 'CDs', reports, etc. per protocol.
Maintaining ongoing communication with Primary Care Provider and Specialist document requirements for all appointments.
Coordinate procedure guidelines with appropriate personnel prior to the specialty medical appointment for accurate patient care (i.e. medication regimens, fasting, surgical procedures, etc.). Provide information and updates on the status of scheduled contracted provider appointments to patients and IDT staff. Perform all other related duties as assigned.
High School graduate or GED equivalent required. A minimum of two years' experience working in medical or clinical field required.
Experience working with referrals/authorizations and with an Electronic Health System is preferred. CPR/First Aid certificate required.