Clinical Service Support

3 weeks ago

Vista, United States PHYSICIANS DATA TRUST Part time $18 - $22
Job DescriptionJob Description

Primary Purpose:

The primary function is to support the case management team in completing their MOC (model of care) tasks as well as provide assistance with obtaining audit deliverables for the MediCal programs.

Principal Duties and Responsibilities:

  • To communicate, at all times, verbally or written, in a timely, courteous & professional manner
  • To collaborate with the case managers to ensure all members are assisted with the coordination of care/MOC
  • D SNP coordination includes:
    1. Review the daily hospital discharge report
    2. Creation/maintenance of transition of care (TOC) for DSNP members upon hospital admission
    3. Retrieve and review LA Care health plan reports: HRAs
    4. Retrieval of incoming faxes and upload to Cozeva
    5. Maintain and record information received from the D-SNP nurses
    6. Retrieve letters from the LA Care SFTP site
    7. Download Scan HRAs from the SFTP site; weekly
    8. Risk Stratification Report for CVPG & STV; monthly
    9. Transfer-out/ transfers-in from LA Care report retrieval from the SFTP site; monthly
    10. D-SNP program logs 1.5, 1.6, and 1.12 for CVPG & STV; Quarterly
    11. Scan SNP Tracking & Metric logs quarterly submission
    12. Monthly LA Care report MOC 24
  • Integrate behavioral health in collaboration with the PCP (primary care physicians) and CM when indicated
  • Identify and refer members to ACM (ambulatory case management) when indicated
  • Ensure all specialty notes are shared with the CM and the PCP
  • Help to coordinate transportation for members
  • Refer members to community-based resources when appropriate
  • Assist the CM in all aspects of ACM within the scope of job responsibilities
  • To assist the case manager in preparing for D-SNP audits
  • To maintain a tracking system for health risk assessment (HRA), transitions of care (TOC) and inter-disciplinary care plan (ICP) completion dates
  • To populate and submit the requested D-SNP reports on time to the health plans
  • Retrieval of office records for health plan audits when requested. This includes but is not limited to, CCS (California Children Services) file retrieval/ coordination, Medi-Cal specialty referral file retrieval/coordination, sterilization consent forms, as well as maintaining and tracking ACHA and lead testing
  • To organize, manage, and prioritize workload effectively
  • To maintain daily, weekly, or monthly reports as requested
  • To assist in the preparation of meetings
  • To perform other duties as assigned
  • To maintain a courteous and professional demeanor in all interactions, with all persons both inside and outside the office
  • Job Specifications (KSAs):
    • The ability to read, write, and speak English and perform other basic educational skills as is generally obtained by completing High school or a GED equivalent
    • Clear and accurate knowledge of medical terminology; managed care experience and knowledge
    • Demonstrated computer literacy Microsoft program expertise, especially with Word and Excel, required
    • Excellent communication skills in both oral and written modes, as well as superior telephone etiquette
    • Excellent Customer Service required
    • The ability to work well with a team
    • Position Performance Criteria:
      1. Maintains or exceeds quantitative productivity standards and accuracy standards on a daily basis
      2. Maintains professional behaviors, demeanor and work habits consistent with both departmental & company policies and procedures
      3. Maintains good customer relationships with both provider office staff and providers as well as effective and courteous communication with internal staff
      4. Positively contributes to the utilization management team via effective communication and problem-solving within the framework established by the department
      5. Communicates, professionally, and respectfully to peers, superiors, subordinates, and clients
      6. Uses sound judgment concerning time management and prioritization of work to balance multiple tasks and meet required timeframes for all administrative activities as required
      7. Demonstrates high reliability through consistent punctuality and attendance.

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