Coordinator, Long Term Care / Job Req 604279767

PRINCIPAL RESPONSIBILITIES:

The Long-Term Care Coordinator will support clinical staff through completion of the administrative and nonclinical coordination functions. The Long-Term Care Coordinator is responsible for continuous processing and monitoring of the review and authorization process and ensuring that corresponding documentation are received timely. The Long-Term Care Coordinator will be responsible in ensuring the quality and accuracy of any corresponding documentation. This position exercises considerable discretion and independent judgement in the performance of duties and responsibilities while complying to any and all regulatory guidance.

Principal responsibilities include:

• Maintain, coordinate, and prioritize authorizations to LTC nurses, vendors, LTC Providers and LTC facilities in a timely manner as needed.
• Collaborate with Medical Director, LTC Management and clinical staff as well as other departments at the Alliance to receive, date, document and resolve inquiries/issues for claims, authorizations, appeals and eligibility. Perform these duties in a professional and timely matter. This includes performing a preliminary processing of complaints and grievances.
• Accurately interpret and communicate member benefits to Provider and Facility network and serve as resource for nurses and the IT Department in verifying and resolving member eligibility.
• Run scheduled and ad hoc reporting on utilization data, including “hold” status authorizations; identify trends.
• Receive and respond to claims issues related to an authorization.
• Establish, facilitate, and maintain effective ongoing relationships with network hospitals, SNFs, delegated groups, vendors and providers; facilitate communication and care coordination between network entities
• Complete other duties and special projects as assigned.
• Respond to provider, member, and staff inquiries at any given time in a professional and timely manner.
• Process and coordinate any supportive services; (DME, Transportation, therapies).
• Process and issue member and provider notifications (mail, fax, electronic media, telephone).
• Utilize established Long-Term Care (Title 22) guideline pathways for screening, authorizing, and finalizing authorization (Bed Holds, Leave of Absence) requests.
• Prioritize, maintain, coordinate, process accurate and timely Long-Term Care admissions, and transitions throughout the continuum.

ESSENTIAL FUNCTIONS OF THE JOB

• Prioritize and Multi-task.
• Comply with organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures and internal controls.
• Collaborate with Long-Term Care Providers, Skilled Nursing Facility staff, Hospitals, Delegated partners, and Internal businesses.
• Communicate effectively, both verbally and in written format.
• Perform writing, administration, and data entry into multiple platforms.

PHYSICAL REQUIREMENTS

• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Extensive data entry using keyboard and/or mouse.
• Frequent walking and standing.
• Constant sitting and working at desk.
• Constant and close visual work at desk or computer.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Occasional driving of automobiles.
• Occasional travel to hospitals and other facilities.
• Occasional travel between offices for meetings

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• High School diploma and equivalent combination of education and experience.
• Bachelor’s degree or higher in a healthcare related field or
• AS/AA degree or two (2) years of college with a minimum of one-year experience crafting healthcare related assessments and referrals, or

Licenses/Certifications

• Active & Current Driver's License, with a clean record and Auto Insurance, required

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• One (1) year experience in managed care or health care setting preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Experience with Medi-Cal and Medicare populations and regulatory requirements.
• Excellent verbal and written communication skills.
• Proficient in use of computer and supporting software in a Windows-based environment including with Microsoft Office applications and use of the internet/internet applications.
• Working knowledge of health care benefit eligibility requirements
• Experience in skilled or long-term care facility settings.
• Knowledge of DMHC regulations and DHCS contractual requirements.
• Experience in utilization review, skilled nursing services, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies

Additional Duties

• Job may require travel to facilities, Hospitals, Skilled Nursing Facilities, and Intermediate Care Centers
• Travel to offsite locations for work.

SALARY RANGE: $38.48 - $57.72 Hourly

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.