Referral Coordinator

We’re unique. You should be, too.

We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

ESSENTIAL JOB FUNCTIONS:
The Care Coordinator will work with Care Center of Excellence, Physician Management Resources (PMR), market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management in ChenMed Medical Centers.
Primary Duties and Responsibilities

• Daily review of approved and pended outpatient requests for PMR clients and ChenMed Markets.
• Provide insights to the PMR team and Network Director and work with them to take action.
• Facilitate a daily process to help redirect poorly supported requests by:
  
  • Providing feedback to Humana, Careplus, Wellcare and Coventry and working through daily authorization requests when information is missing.
  • Create process for managing requests when patients need to see the primary care provider by coordinating with primary care provider and Market leaders.
  • Enable a member of PMR network or clinical team to reach out to authorization requester when deemed necessary.

Other responsibilities may include:

• Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible one dependent on market needs.
• Travel as needed to PMR & ChenMed markets for training and support.

KNOWLEDGE, SKILLS AND ABILITIES:

• Excellent analytical skills in order to solve the complex and logistical problems.
• Strong communication and interpersonal skills, both written and verbal, as well as delivery skills for presentations and training.
• Excellent organizational skills with ability to effectively manage multiple tasks and responsibilities.
• Ability to deliver efficient, high quality results within tight deadlines.
• Works well independently and within a team.
• Excellent influencing and negotiation skills.
• Ability to explain complicated financial terms and utilization data to physicians/staff.
• Ability to understand, interpret and communicate all types of provider, regulatory contracts and utilization management data.
• Fluent in English.

EDUCATION / SPECIALIZED KNOWLEDGE REQUIREMENTS:

• Bachelor's degree.
• 3 years Utilization Management and/or Provider Relations or Healthcare Analyst experience or similar background.
• Advanced MS Word and Excel.
• The ability to establish credibility quickly and the willingness to take a strong approach to leadership.

• An understanding of the communities that ChenMed and PMR serves, including the complexities of Medicare programs to patients in the current healthcare marketplace.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of medical terminology, CPT, HCPCS and ICD coding desired
• An understanding of the company's patient population, including the complexities of Medicare programs
• Exceptional organizational skills with the ability to effectively prioritize and complete tasks in a timely manner.
• An understanding of the company's patient population, including the complexities of Medicare programs
• Detail-oriented with the ability to multi-task.
• Able to exercise proper phone etiquette.
• Ability to navigate proficiently through computer software systems & use technology.
• Ability to work well with patients, colleagues, physicians and other personnel in a professional manner.
• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, database, and presentation software.
• Spoken and written fluency in English; bilingual preferred.

EDUCATION AND EXPERIENCE CRITERIA:

• High School diploma or equivalent required
• A minimum of 1 year of referral experience in a healthcare setting required.
• Experience with web-based insurance sites and obtaining referrals/authorizations for multiple payors preferred.
• Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred
• Healthcare experience within the Medicare Advantage population preferred.
• Medical Assistant certification preferred
• CPR for Healthcare Providers is preferred