Project Specialist

Job Description

Position Summary:

The Project Specialist is responsible for supporting the Northwest project management team and campus operational leaders such as the campus Regional Medical Directors, VP of Clinical Operations and Sr. Director of Administrative Operations. The Project Specialist will also serve as a backup to our Campus Analysts with any second signature referrals and preparation. Lastly, the Project Specialist will monitor all necessary inpatient and outpatient authorization queues to ensure regulatory turnaround time compliance, assist with expediting finalization of referrals, and triage requests that may require additional information prior to Regional Medical Director finalization.

The Project Specialist will provide support in case management reporting and disease management driven programs. They will work closely with the Project Managers with managing the advance care planning (ACP) data base, which is not limited to data entry, creating new enrollment cases, referrals, updating existing cases, generating reports and presenting them to the operational leaders. They will help handle ACP referrals and help monitor all activities, create ad hoc daily reports, assist with all attachments and review any term reports, productivity reports, help manage and operate the database for the Northwest region.

The Project Specialist will be responsible for assisting the inpatient case management team with managing the elective referral report. The expectation is for the Project Specialist to engage and connect with external healthcare professionals to obtain surgical dates and update our case notes in our network.

The Project Specialist will be responsible with updating the report regularly and send notifications to the inpatient case management team to make them aware of the upcoming elective procedure. In addition, the Project Specialist will assist with obtaining ancillary orders and help with the arrangement and coordinator of any durable medical equipment that is needed prior to admission and work closely with the department inpatient supervisors with assigning cases to inpatient coordinator staff.

The Project Specialist will help engage and communicate closely with a large group of Primary Care Physicians to help obtain admitting orders, important process notes and any helpful medical records.

The Project Specialist will also provide administrative support to a variety of case management projects for both the inpatient and outpatient progress as hospice and ACP referrals are identified from different settings. In addition, the Project Specialist will be responsible for helping the project management maintain and update our in-house resource materials, job aids, auditing tools for all staff to reference as a guide when additional clarification is needed.

Essential Duties and Responsibilities include the following:

“First line” resource for inpatient inquiries. Responsible for compiling coordinator audit questionnaires. Reflecting current processes and will be responsible for updating and maintaining the questionnaires as processes change. Make daily outgoing calls to in-network specialty providers to confirm if the members who were approved for surgery Responsible for developing and maintaining resource material, job aids, auditing tools for all staff to reference as a guide when additional clarification is needed. Serve as front line support with inpatient and outpatient authorization requests, in effort to capture any leakage and continue to train staff in an effort to prevent and avoid leakage. Work in collaboration with the department staff to assist with daily operations and management of the ACP database and intake referrals Complete assigned tasks accurately and within specified time limits. Anticipate future events, set realistic goals, timetables, coordinate activities to ensure smooth work flow and time management. Communicate closely with a large group of Primary Care Physicians to help obtain admitting orders, important process notes and any helpful medical records Identify and schedule ongoing training sessions for established staff to review processes with the department trainer where deficiencies appear in audits. Help create ad hoc daily reports, assist with all attachments and review any term reports, productivity reports, Anticipate our provider’s needs: Understand their wants and needs, listen for cues and identify how to respond and what level of intervention they need. Returns phone calls to providers and follow up with requests in a timely fashion, as necessary with regards to tasks at hand. Assist the project management team with making outgoing calls to in-network specialty providers to confirm if the members who were approved for surgery have been scheduled for their procedure. Work closely and help our department Clinical Liaison with calling different hospice agencies and advance care planning referrals. Recognizes when an error has been made and immediately correct it then report to appropriate manager. Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs. Conduct daily audits by running reports using our proprietary tools such as Tableau and help all staff in the Northwest region ensure that any referrals that are generated/processed by staff meet regulatory turn-around-times. All other duties as directed by management. The pay range for this position at commencement of employment is expected to be between$22 - $24 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

Employer-paid comprehensive medical, pharmacy, and dental for employees Vision insurance Zero co-payments for employed physician office visits Flexible Spending Account (FSA) Employer-Paid Life Insurance Employee Assistance Program (EAP) Behavioral Health Services Savings and Retirement:

401k Retirement Savings Plan Income Protection Insurance Other Benefits:

Vacation Time Company celebrations Employee Assistance Program Employee Referral Bonus Tuition Reimbursement License Renewal CEU Cost Reimbursement Program Business-casual working environment Sick days Paid holidays Mileage Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Requirements

Education and / or Experience:

High school graduate required; Associates degree or higher preferred. Knowledge of Healthcare and Managed Care preferred, but not required. Typing 40 word per minutes with accuracy. Knowledge of computers, faxes, printers and all other equipment. Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point). Ability to deal with responsibility with confidential matters. Ability to work in a multi-task, high stress environment. Ability to prioritize. Ability to meet deadlines and ensure regulatory compliance.

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