Long Term Coordinator

Job Details

Long Term Coordinator

San Berandino, California




Job Description

Long Term Care - Coordinator

Local Healthcare Plan Provider in the Inland Empire is seeking an/a Long Term Care Coordinator to join their team! Making a difference to improve the lives of their members – providers – team member and community.  This great team is looking for someone to help organize and improve the delivery of quality, accessible and wellness based health care services.  If you are looking for the opportunity to impact the lives of others - Please call our office (951) 683-3753 or email ehernandez@ttstaffing.com to be considered.

What a Day on the Job Looks Like:

  • Responsible for monitoring the Right Fax Server for the long term care team.  Ensuring all orders are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
  • Responsible for meeting the performance measurement standards for productivity and accuracy for processing of orders/admit face sheets.
  • Responsible for representing the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
  • Communicate with providers in consultation with the Long Term Care Review Nurse, regarding authorizations, denials and other matters pertinent to processing authorization requests or other UM related correspondence.
  • Assist Management or Utilization Management Nurses as requested.
  • Assist with placement of IEHP Members to long term care from the community and those transitioning from an inpatient facility.
  • Attaching reviews and orders into the medical management system for review by the Long Term Care Review Nurse.
  • Performs basic, initial review of the Minimum Data Set (MDS) received on each custodial care Member from the skilled nursing facility.
  • Verify eligibility on each Member in long term care at the beginning of each month
  • Create authorization for bed holds and follow up to determine if Member has returned to the original facility and complete authorization.  

What you need to be considered:

  • Minimum of three years of experience as a data entry specialist.
  • Utilization Management experience preferred. Data entry specialist experience preferably in an HMO or Managed Care setting.
  • High school diploma or GED required.
  • Preferred Education
  • Professional Certification - Medical assistant certification preferred.
  • Knowledge of computer applications, including word processing, database and spreadsheets. Requires knowledge of ICD-9 and CPT codes. Understanding of and sensitivity to multicultural community. Knowledge of CMC and Medi-Cal/managed care environment.

Excellent communication and interpersonal skills. Strong organizational skills. Skilled in Windows applications. Skilled in data entry.

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