This Case Coordinator will be responsible for facilitating out of network admissions and transfers under the direction of the on call physician. Facilitates hospitalist orders for discharge planning. Also responsible for taking after-hours calls from IPA members regarding urgent care facility location and authorization requests Schedule: Saturday and Sunday 8am-5pm Telecommute- Work from Home If you are located in California, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:
- Manages the facilitation of after- hours discharge orders from acute, SNF facilities and ER such as home health, DME orders and ambulance transfers
- Verifies eligibility & benefits on health plan websites
- Arranges transfers from out of network to in-network and emergent/urgent tertiary transfers for higher level of care
- Identifies and communicates high dollar/high risk cases, and also CCS admissions
- Ensures the appropriate utilization of capitated and contracted specialists providers, facilities, and vendors according to region and risk
- Returns calls to ERs, Hospitals, SNFs and physicians within 10 minutes of page, text or call
- Ensure home lap top computer is available at all times during on-call hours and ability to text by cell phone
- HS Diploma or GED
- 2+ years of experience as an inpatient UM coordinator
- Knowledge of HMO, MSO, and ACO structures and operations
- Knowledge of standardized CMS, Medicare Advantage, HMO, and Medi-Cal benefits
- Associates degree
- Computer literate in Microsoft Word and Excel
- Knowledge of CPT and ICD coding
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.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: UM, Coordinator, inpatient, medical terminology, CPT, ICD-10, HMO, MSO, ACO, CMS, Telecommute, La Palma, CA