Clinical Liaison, Client Support Center Specialist

4 weeks ago


Los Angeles, California, United States MedPOINT Management Full time
Job Overview

MedPOINT Management seeks a skilled Clinical Liaison to assist Client Support Center staff with IPA approval workflows that require escalation, expedited handling, or additional clinical information to finalize authorizations.

Key Responsibilities

  • Assist Client Support Center leadership and staff to expedite approvals or updates of appropriate authorizations or the receipt of information from UM to determine authorization decisions.
  • Notify Client Support Center staff of authorization details contained in LOA utility if information is required to determine authorization decisions.
  • Assist with training Client Support Center staff regarding relevant clinical conditions and treatments.
  • Be available to explain UM workflow and assist with any barriers in the process.
  • Participate in triaging authorizations as necessary to meet timeliness requirements.
  • Assist with taking escalated calls from providers and offices when clinical experience is needed to address providers' inquiries or concerns.
  • Liaise with PNO as needed to determine provider access and availability for escalated clinical cases.
  • Work with Client Support Center leadership to establish an efficient workflow to ensure that cases that meet criteria are moved to the Clinical Liaison priority status.
  • Special projects and tasks as required.

Requirements

  • Current LVN or RN licensure.
  • Minimum five years experience working in MedPOINT's inpatient or outpatient UM department.
  • Expertise in Client IPA's business rules, hospital capitation rules, and Outpatient UM Tools.
  • Attention to detail.
  • Capable of consistently meeting deadlines.

Skills and Abilities

  • Effective verbal and written communication skills.
  • Able to work well without supervision.
  • Strong interpersonal skills.
  • Excellent organizational skills and ability to multitask.
  • Ability to work well in a busy department.
  • Able to stay focused on the telephone despite noise and other distractions.
  • Minimum or higher proficiency level with Microsoft Office Programs; primarily Word and Excel 2013 or higher.
  • EZ-CAP knowledge.


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