ChenMed is transforming healthcare for seniors. We provide big answers to big problems in health care delivery. ChenMed is a full-risk primary care market leader with an innovative philosophy, unique physician culture and end-to-end customized technology. These things allow us to provide world-class primary care and coordinated care to the most vulnerable population – moderate- to low-income seniors who have complex chronic diseases.
Through our innovative operating model, physician-led culture and empowering technology, we are able to drive key quality and cost outcomes that create value for patients, physicians and the overall health system. Our model allows us to practice medicine the way it should be practiced. By recruiting focused physicians and reducing their doctor-to-patient ratios, we increase patients’ “face time” during each monthly appointment and help foster stronger doctor-patient relationships. Our model also drives and enhances compliance with treatment plans.
As a result of our efforts, our patients realize lower hospital admissions. Their overwhelming response to our approach is reflected in our aggressive, organic growth and net promoter scores in the low to mid 90s, which is unheard of in any industry. Read more about our results and the value of the ChenMed model.
As a company, we are making a difference in the lives of seniors and the health care system overall.
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.
At ChenMed, If you are an innovative, entrepreneurial minded, over-achiever who is extremely passionate in helping people and revolutionizing Healthcare again, we are that dynamic and exciting company you are looking for!
After applying, we encourage you to “follow” us on LinkedIn (ChenMed) as well! This way you can stay informed and up to date on what’s happening around our organization and start your path to becoming part of our FAMILY!
EDUCATION AND EXPERIENCE CRITERIA:
-
High School diploma or equivalent required
-
A minimum of 1 year of relevant work experience in customer service, patient referrals, and/or insurance verification required
-
Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred
-
Healthcare experience in a clinical setting, preferably within the Medicare HMO population is a plus
-
A valid, active driver’s license in State of employment is required; position may require travel within the market
-
Medical Assistant certification preferred
-
CPR for Healthcare Providers is preferred
Source: Indeed.com
Click Here To Apply
