Vacancy expired!
Like you, UnitedHealth Group is strong on innovation. And like you, we'll go the distance to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have a chance to make an impact.Assists the Care Transitions Nurse with coaching members through the transition of care process. This includes the collection of clinical data for review by licensed clinical staff, coordination of care in the post-acute setting, documenting all activities in accordance with regulatory requirements. The Care Transitions Coordinator may not make decisions which require clinical judgment.Primary Responsibilities:
Conducts post discharge calls on all members discharged from acute, SNF and ER settings at specified intervals
Completes assessments and medication review as directed by licensed clinical services staff and submits for decision-making
Obtains clinical records from admitting facilities
Facilitates patients appointments as directed by the case manager
Ensures all discharge planning is implemented as ordered
Authorizes selected services per physician orders
Advocates for patients as new care coordination needs are identified
Provides feedback to Manager regarding process improvement
Performs data entry
Prepares tracking reports
Files/faxes
Other duties as assigned
Required Qualifications:
High School diploma or equivalent
Medical Assistant Certificate
Valid California Drivers license and insurance
Greater than 1 year experience in managed care environment or 3 years in a medical office or clinic setting as a medical assistant or a referral coordinator is preferred
Knowledge of UM/QM processes and principles
Knowledge of Health Plan compliance requirements
Knowledge of and experience with medical coding
Knowledge of general IPA operations
Computer literate in Microsoft Word and Excel
Knowledge of medical terminology
Strong ability to work effectively with nurses, physicians and other clinical and operational staff, both written and verbally
Self motivated with strong organizational skills
Ability to look at challenges as opportunities
Flexible and adaptable of schedule to attend various meetings and/or promotional events
Ability to read quickly with excellent comprehension and retention
Bi-lingual Spanish written and verbal fluency skills required
AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords: Transition of care coordinator
Vacancy expired!