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Long Term Care Coordinator

Company: Alura Workforce Solutions
Location: Rancho Cucamonga
Posted on: January 12, 2021

Job Description:

PositionLong Term Care CoordinatorDescriptionUnder 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.- 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 face sheets. 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 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.Requirements* Minimum of three years of experience as a data entry specialist.* Utilization Management experience preferred. Data entry specialist experience preferably in an HMO or Managed Care setting.* High school diploma or GED required. * Medical assistant certification preferred.* 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.* Excellent communication and interpersonal skills. Strong organizational skills. Skilled in Windows applications. Skilled in data entry.* Telephone courtesy. High degree of patience.

Keywords: Alura Workforce Solutions, Rancho Cucamonga , Long Term Care Coordinator, Other , Rancho Cucamonga, California

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