Overview:
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!
Under the general direction of the Supervisor of the Non-Routine Placement (NRP) team, the Non-Routine Placement Coordinator is a high paced position that requires timely processing of Program Referrals, verifying eligibility, and obtaining additional information as requested by the Non-Routine Placement Nurses. This position requires the incumbent to be organized with the ability to multitask with a working knowledge of ICD 10, CPT coding and Medical Terminology. The Non-Routine Placement Coordinator will work as an extension of the NRP clinical team to complete all non-clinical functions as indicated.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits:
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
- Competitive salary
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
Key Responsibilities:
- Ensure all face sheets (hard copies and electronic face sheets) are complete and accurate to reflect current member demographic information to support Non-Routine Placement (NRP) processes. Monitor the Right Fax server, EDI Interface, and medical management system ensuring intake is processed in a timely manner
- Review the daily census report to eliminate duplicates or other admissions received not required by the health plan from all contracted and non-contracted facilities
- Verify eligibility and assign authorization to appropriate NRP nurse based on the Far tool
- Attach reviews and orders into the medical management system for review by the NRP nurse
- Obtain member discharge dates through daily calls, Electronic Medical Record review, or memo submissions to contracted and non-contracted facilities
- Ensure timely processing of program referrals and member discharges
- Contact providers by phone, fax, or email to request additional medical information to support referral process
- Communicate with providers/facilities in consultation with the NRP Nurse, NRP Specialists, and others regarding program referrals, orders, and clinical reviews
- Assist the NRP Nurse in coordination of care of members identified with care management conditions. Set up hospital follow-up appointments for members as needed and provide details to members. Document call interactions within the medical management system
- Collaborate on members’ care issues with applicable internal teams and consult with Hospital & Ancillary Department Leadership to ensure appropriate treatment plans are followed, thoroughly and promptly
- Assist with identifying HEDIS Gaps and outreach to address with member
- Ensure all documentation is accurate and in compliance with regulatory requirements and accreditation standards
- Support workflow improvements and department initiatives
- Perform any other duties as required to ensure Health Plan operations and department business needs are successful
Qualifications:
Education & Requirement
- Minimum of two (2) years of experience as a data entry specialist in a customer service-oriented environment
- Data entry specialist experience preferably in an HMO or Managed Care setting
- Utilization Management experience preferred
- High School Diploma or GED required
Key Qualifications
- Requires knowledge of ICD 10 and CPT codes. Knowledge of utilization management in a health care delivery setting preferred
- Skilled with computer applications, including word processing, databases, and spreadsheets. Good customer service skills.
- Proven ability to:
- Meet performance measurement standards for productivity and accuracy
- Represent the organization in a friendly and professional manner while answering calls
- Promote a positive and collaborative working environment within the team
- Participate in scheduled meetings
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location:
This position is on a hybrid work schedule. (Monday & Friday - remote, Tuesday – Thursday onsite in Rancho Cucamonga, CA.)
Pay Range:
USD $23.98 - USD $30.57 /Hr.