Clinical Liaison, RN

1 day ago

Northridge, United States Regal Medical Group Full time
Job Description

  1. Essential Duties and Responsibilities include the following:
1. The Clinical Liaison will collaborate with the Regional Medical Director(s), prior authorization team and the network management team to develop an efficient and effective network for the delivery of care to members of the LA campus/region

2. The Clinical Liaison will collaborate with the decision support to provide actionable data to the RMD and other stakeholders in the management of the campus.

3. Work as a clinical subject matter expert and as medical management’s liaison to other stakeholders in the network development project.

4. Assesses and collaboration with network physicians, and other healthcare practitioners.
  1. Performing GAP analysis with the network and identifying the appropriate physicians, health care vendors and facilities in order to provide the highest level of care, in the most efficient manner, while utilizing only the resources necessary for that episode of care.
6. Collaboration with clinical team to ensure synchronization of sub-areas' operations to reach regional goals set forth by the regional medical director.

7. Network management/development: develop tools and training curricula to educate providers and their staff how to meet expectations and goals as prescribed in their contract.

8. Responsible for working collaboratively with the Regional Medical Director and Medical Management team to ensure network growth and development initiatives are being met and are networks are operating within budgets.

9. Maintaining and updating the appropriate databases and department tools with current information.

10. Daily interaction with regional providers and at visits to PCP and Specialist offices as needed.

11. Internal network liaison for Database, Claims, Customer Service, Medical Management, and Quality Management Departments.

12. Know and follow the Employee Handbook policies and procedures.

13. Maintain patient confidentiality so that HIPPAA compliance is observed at all times.

14. Other duties may be assigned as needed.

Distribution of work:

· Daily production will vary from day to day. All assigned work must be completed by the end of business day in order to maintain turnaround time compliance.

Special Projects:

· Assist with any special projects.

The pay range for this position at commencement of employment is expected to be between $45- $50 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


Requirements

Education and/or Experience:
  1. Must hold a BSN or equivalent.
  2. Minimum of 2 years relevant work experience in a managed care setting, health plan or large medical group administration.
  3. Knowledge of the prior authorization process.
  4. Knowledge of contracting principles/tools. (preferred)
  5. Excellent verbal and written communication skills.
  6. Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
  7. Must be able to travel within service area and have valid driver’s license and insurance (preferred)

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