HLOC Care Coordinator
3 weeks ago
About the Role:
As a HLOC Care Coordinator at MedPOINT Management, you will play a critical role in ensuring the smooth coordination of higher-level care cases and transplant processes. This is an excellent opportunity to utilize your skills and experience to make a positive impact on patient care.
Key Responsibilities:
- Maintain updated lists of HLOC facilities and ensure that workflows are efficient and effective.
- Develop and maintain cheat sheets for go-to specialists and list hospitals with special procedures.
- Oversee HLOC cases and inpatient transplant cases, ensuring clear communication and documentation.
- Obtain authorizations from individual health plans when needed and ensure condition codes are added for members requiring transplants.
- Submit LOAs for non-contracted providers and facilities when necessary.
- Assist Medical Directors as needed, referring potential readmissions and quality-of-care issues.
Requirements:
- Current RN or LVN licensure; Preferred: BSN level of education.
- Working knowledge of case management philosophy, principles of utilization review, quality assurance, and reimbursement structures.
- Ability to read, analyze complex clinical data, and apply it to level of care criteria and discharge options.
Salary: $78,000 - $100,000 per year, depending on experience.
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