Care Coordinator

Join Our Team!Responsible for maintaining and managing internal and external utilization processes in a timely and accurate manner consistent with HealthCare Partners's policies and procedures and as described in the Utilization Management Plan.
Performs effective prospective and concurrent review of request for services according to established guidelines and time frames.
Documents member's service benefits by contacting the appropriate health plan as needed.
Directs providers/members to contracted provider network and facilities.Assists and monitors processing of referrals and enters, updates and closes referrals daily while assuring that: Appropriate internal/external referral providers are utilized. Members are eligible and have benefit coverage. Correct CPT/ICD-9 codes have been entered. Accurate record of all dates and other required fields is entered. Supporting clinical data for the referral is entered. All urgent referrals are processed within designated time frame.
Prints and mails authorizations to providers, patients, HMO's and facilities as needed.
Processes referrals for Durable Medical Equipment and coordinates Home Health Services according to established policies, procedures and guidelines.
Coordinates, identifies and routes referrals that require review to licensed Care Management staff who arranges outside physician medical review as appropriate.
Assists with answering telephones and maintaining files, logs or other reporting.Assists other Care Coordinators as needed and in covering for absent personnel.
Processes referrals for inter-facility transfers using pre-established guidelines.
Processes after hours emergent/urgent care logs/lists as needed.
Collects and prepares medical records for review when appropriate/requested.
Interacts in a professional manner with specific health plans, area hospitals and providers while maintaining confidentiality.
Responsible for processing appropriate authorizations for HMO/PPO clients as specified in the HealthCare Partners procedures.
Acts as a resource to other coordinators, staff and providers by resolving issues and responding to requests in a timely and effective manner.
Process elective surgical requests with coordination of surgery dates and notification of inpatient team, Hospitalist/Care Manager when appropriate.
Works with Patient Services regarding member concerns.
Performs special projects and other duties as requested by supervisor.
REQUIREMENTS
Over 1 year and up to and including 3 years of experience.
A high school diploma, G.E.D. or equivalent. Includes special certification required for specific jobs.
Ability to use computer systems efficiently and effectively.Excellent communication organization and customer service skills.
Knowledge of medical terminology and CPT ICD-9 coding.
30 wpm typing skills.
Attentiveness to detail.
Proven ability to problem solve.
Manage time effectively and work independently.