Outpatient Referrals Clinical Coordinator
3 weeks ago
Job Title: Outpatient Referrals Clinical Coordinator
Job Summary:
We are seeking a skilled Outpatient Referrals Clinical Coordinator to join our team at Community Health Group. As a key member of our healthcare team, you will be responsible for assessing, planning, and coordinating optimal and timely care delivery for our members along the entire continuum of care.
Key Responsibilities:
- Use clinical judgment to review, monitor, and coordinate requests for services, proposed surgical procedures, and specialty services requests.
- Coordinate reviews not meeting pre-certification guidelines with Medical Director or Chief Medical Officer for determination.
- Apply standard, plan-designated clinical guidelines to monitor, review, and coordinate proposed services for adult and pediatric populations.
- Forward quality of care concerns to QI using criteria for identification of these cases.
- Collaborate with providers of care, patient, and significant others to arrange for alternative care.
Requirements:
- Graduate from an accredited school of nursing.
- Registered Nurse (RN) in CA (active and unencumbered status).
- BSN degree in nursing or other health-related field and certification in utilization review and/or case management preferred.
Preferred Qualifications:
- 3 years of experience working in an acute care facility (ICU, emergency department, and/or medical/surgical unit) and 1 year of experience in a managed care environment.
- Inpatient discharge planning, high-risk management experience, or outpatient referral management preferred.
About Us:
Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws.
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