Job Description

Responsibilities for this position include completing non-clinical tasks related to supporting the Inpatient Care Management Program so that it functions in a smooth and efficient manner and to assist the supervisor and or VP of Inpatient Case Management as needed. This includes ensuring that all necessary clerical functions from the time of hospitalization through discharge, inclusive of required follow-up care are completed accurately and timely by the campus coordinators. Primary functions include updating and maintaining the hospital daily census and identifying significant coordinator task duty imbalance and reporting such issues to the management team for possible process review. Assist in facilitating hospital provision of required patient information and to support the Inpatient Case Manager

Essential Duties and Responsibilities include the following:

• Assist the Manager of Inpatient Case Management with the non-clinical functions of Inpatient Case Management Department.
• Acts as a resource to the Inpatient Case Management coordinators when supervisor is off premises.
• Communicate with supervisor and VP of Clinical services on a daily basis.
• Train Case Managers and Coordinators to computers systems and Inpatient process.
• Direct calls to the appropriate physicians.
• Summarize all new overnight admission and inform the rest of the clinical team by 9am.
• Open cases for admission accurately and timely for assigned hospitals and assist in auditing other coordinators to ensure correct processes have been followed.
• Communicate daily with Care Management Nurses to assist with eligibility and benefits.
• Checks eligibility and benefits when required.
• Process all ambulatory authorizations for designated hospital at the direction of the C.M. Nurse.
• Process ancillary discharge authorizations for members as needed and fax to appropriate vendor.
• Assist with auditing coordinators utilization of preferred ancillary providers.
• Assist in re-training for any utilization errors.
• Fax or E-mail hospital documentation (H&P and D/C summary) to PCPs for each patient.
• Daily review patient information on designated logs for accurate admit, discharge date, etc.
• Prepares appropriate denial letter at the direction of the C.M. Nurse.
• Maintains confidentiality of all patients and medical/clinical information.
• Monitoring incoming fax server and flag each fax with the standard color system to ensure proper routing of data; reporting any discrepancies to management.
• Attend management meetings to ensure full understanding of communication of these new processes to the team and assist supervisor with the new auditing tools.
• All other duties as directed by management.

Organizational Responsibilities :

• Proactively support and practice company mission, vision and values.
• Follow Employee Handbook guidelines and company policies and procedures.
• Follow established departmental dress code.
• Appropriately and accurately maintain time keeping records.
• Adhere to attendance policy and time off requests.
• Follow safety policies and procedures.
• Be flexible and adaptable and courteous and promote professionalism.
• Communicate verbally and in writing through appropriate channels.
• Maintain confidentiality at all times in compliance with company policy and HIPAA requirements.
• Employee has completed all required annual Compliance training and signed attestation form is attached for each module.

Compliance:

This position requires that the Employee abide by the Company’s Compliance Plan (including its Standards of Conduct) and all Compliance Policies and Procedures (as listed on the Company’s Intranets or Internet pages under Compliance). This position further requires the Employee to act with the highest standards of integrity and professional ethics. This would include but is not limited to the expectation and requirement that the Employee immediately report any potential Compliance, Security or Privacy, or potential Fraud-Waste-Abuse violations or issues to the Company’s Compliance Officer, Compliance Hotline, and/or to any Officer of the Company.

The pay range for this position at commencement of employment is expected to be between $26-$28/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Qualifications

Education and/or Experience:

• High school diploma or general education degree (GED); and at least one year related experience.
• Medical terminology, ICD9 and HCPC coding, LEAD (Access Express), EZ-Cap, IDX. Good phone etiquette required.