Long Term Care Coordinator

Title: Coordinator, Long Term Care

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:

• Prioritize, maintain, coordinate, process accurate and timely Long-Term Care admissions, and transitions throughout the continuum.Â
• Process and coordinate any supportive services; (DME, Transportation, therapies).
• Process and issue member and provider notifications (mail, fax, electronic media, telephone).
• Establish, facilitate, and maintain effective ongoing relationships with network hospitals, SNFs, delegated groups, vendors and providers; facilitate communication and care coordination between network entities
• Utilize established Long-Term Care (Title 22) guideline pathways for screening, authorizing, and finalizing authorization (Bed Holds, Leave of Absence) requests. Â
• Run scheduled and ad hoc reporting on utilization data, including â€hold†status authorizations; identify trends.
• 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.
• Receive and respond to claims issues related to an authorization.
• 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.
• Respond to provider, member, and staff inquiries at any given time in a professional and timely manner.
• Maintain, coordinate, and prioritize authorizations to LTC nurses, vendors, LTC Providers and LTC facilities in a timely manner as needed.

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

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

• Occasional driving of automobiles.
• Occasional travel between offices for meetings

• Bachelorâ€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
• High School diploma and equivalent combination of education and experience.

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

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

• Experience with Medi-Cal and Medicare populations and regulatory requirements.
• 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
• Working knowledge of health care benefit eligibility requirements
• 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.
• Excellent verbal and written communication skills.
• Experience in skilled or long-term care facility settings.