Coordinator - LTC

Date: Aug 5, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7738 

 

Position Summary/Position

 

Under the general direction of the Long Term Care Nurse Manager and Supervisor, the LTC Coordinator is a high paced position that requires timely processing of authorization requests, verifying eligibility, obtaining additional information as requested by the Long Term Care Review Nurses, managing LTC reports, assisting with skilled nursing placement, and review of custodial documentation received by the facilities. This position requires that one be organized with the ability to multi-task with a working knowledge of ICD.10, CPT Coding and Medical Terminology. The UM Coordinator will also ensure that provider calls are responded to in an accurate and timely manner.

Major Functions (Duties and Responsibilities)

 

1. Responsible for monitoring the Right Fax Server for the long term care team.  Ensuring all orders are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
2. Responsible for meeting the performance measurement standards for productivity and accuracy for processing of orders/admit facesheets.
3. Responsible for representing the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
4. Communicate with providers in consultation with the Long Term Care Review Nurse, regarding authorizations, denials and other matters pertinent to processing authorization requests or other UM related correspondence.
5. Assist Management or Utilization Management Nurses as requested.
6. Assist with placement of IEHP Members to long term care from the community and those transitioning from an inpatient facility.
7. Attaching reviews and orders into the medical management system for review by the Long Term Care Review Nurse.
8. Performs basic, initial review of the Minimum Data Set (MDS) received on each custodial care Member from the skilled nursing facility.
9. Verify eligibility on each Member in long term care at the beginning of each month
10. Create authorization for bed holds and follow up to determine if Member has returned to the original facility and complete authorization.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Leading: Self

Experience Qualifications

 

Minimum of three years of experience as a data entry specialist.

Preferred Experience

 

Utilization Management experience preferred. Data entry specialist experience preferably in an HMO or Managed Care setting.

Education Qualifications

 

High school diploma or GED required.

Preferred Education

Professional Certification

 

Medical assistant certification preferred.

Professional Licenses

Drivers License Required

No

Knowledge Requirement

 

Knowledge of computer applications, including word processing, database and spreadsheets. Requires knowledge of ICD-9 and CPT codes. Understanding of and sensitivity to multicultural community. Knowledge of CMC and Medi-Cal/managed care environment.

Skills Requirement

 

Excellent communication and interpersonal skills. Strong organizational skills. Skilled in Windows applications. Skilled in data entry.

Abilities Requirement

 

Telephone courtesy. High degree of patience.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Work Model Location

Physical Requirements

 

Starting Salary: $45,884.80  - $55,993.60  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles