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Referral Coordinator

Alura Workforce Solutions

Rancho Cucamonga, CA

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JOB DETAILS
SKILLS
Behavioral Health, Certified Medical Assistant, Clinical Information, Communication Skills, Current Procedural Terminology (CPT), Customer Support/Service, Data Entry, Demographics, Documentation, English Language, Fax Machines, Health Information Management, Health Maintenance Organization (HMO), Health Plan, Healthcare, Healthcare Management, Healthcare Software, High School Diploma, Hospital, ICD-10, Interpersonal Skills, Leadership, Maintain Compliance, Maintenance Services, Managed Care, Medi-Cal, Medicare, Microsoft Access Database, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft Word, Multicultural, Multilingual, Operations Planning, Organizational Skills, Presentation/Verbal Skills, Process Management, Regulations, Regulatory Compliance, Spanish Language, Utilization Management, Web Forms, Writing Skills
LOCATION
Rancho Cucamonga, CA
POSTED
30+ days ago
POSITION
Behavioral Health Coordinator

Position Type: Temporary
Schedule: M-F, 8:00 am - 5:00 pm Hybrid (Mon & Fri - WFH, Tues - Thurs - Onsite)
Assignment Length: Approximately 6-Months, possibly longer.

DESCRIPTION
Under the direction of the department leadership, the Coordinator - Behavioral Health is responsible for the facilitation and support of Behavioral Health coordination of care activities and assists with the coordination of daily Behavioral Health utilization review functions to ensure overall compliance with regulatory agencies.
  1. Evaluate referral web forms/faxes for completeness and obtaining missing demographic or clinical information as necessary to ensure Behavioral Health Specialists and Behavioral Health Care Managers can make a determination on Behavioral Health authorization service requests
  2. In consultation with Supervisor and designated staff, the coordinator is responsible for the utilization review of Coordination of Care/Discharge Summary Web Forms, which may require linking Members to additional resource
  3. Assist with the utilization review process by contacting providers by phone, fax, or email
  4. Communicate inconsistencies with data or Behavioral Health information to Supervisor or designee
  5. Process tasks from other departments by generating events in the Medical Management System for Behavioral Health Specialist and Behavioral Health Care Managers to review
  6. Collaborate with other staff to ensure all tasks are processed to meet regulatory guidelines
  7. Ensure documentation is accurate and in compliance with regulatory and Behavioral Health standards
  8. Participate in Behavioral Health staff meetings or other meetings as necessary
  9. Any other duties as required to ensure Health Plan operations are successful
REQUIREMENTS
  • Two (2) years of customer service experience required, preferably in a medical clinic or hospital. IPA or Behavioral Health setting required
  • Utilization Management knowledge, including referral process, DSM, ICD-10 and CPT codes preferred
  • High school diploma or GED required
  • Associates Degree from an accredited institution preferred
  • Medical Assistant Certification preferred

Key Qualifications

  • Knowledge of Medi-Cal, Healthy Kids and Medicare required
  • Knowledge of utilization review processes and care coordination in HMO or Managed Care setting preferred. Understanding and sensitivity to multi-cultural community
  • Bilingual (English/Spanish) preferred but not required
  • Must have excellent written and verbal communication and interpersonal skills
  • Strong organizational skills
  • Demonstrated proficiency in Microsoft Office applications (Word, Excel, Access, Outlook, etc.), and data entry
  • High degree of patience and telephone courtesy

About the Company

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Alura Workforce Solutions

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