Job Details

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We're delighted you're considering joining us!

At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description

This position performs a liaison function between clinicians at hospitals, members/patients, providers and nursing facilities and HPMG staff in the HRM, Network Management and related departments. The Supervisor oversees the team of Coordinators. This team supports the concurrent review nurses as they facilitate timely hospital and nursing facility discharges by serving as a point of contact for coordination of inpatient member issues. Receives, and either resolves or routes, requests for assistance with services such as: appointment making, IHMM referral (home physician visiting), inpatient hospital and skilled nursing facility authorization processing, authorizations for post discharge services including home health, equipment and transfers, high risk member information, case management referrals, general questions and other issue/questions as assigned. The Supervisor monitors and tracks issues received to assure timely resolution and feedback communication to referral source. The Supervisor will participate in audits, training, developing workflows and supporting the HRM inpatient team.

Job Responsibilities

Assist nursing staff in obtaining clinical information from facilities and summarizing information for continuing nursing facility stays, processing letters as directed by the CCR/TOC nurses and processing authorizations which require only administrative level of review.

Serve as the contact to receive and process authorizations that are needed to support timely discharge from the hospital or nursing facilities reviews benefit and Health Plan guidelines for appropriateness. Reviews guidelines to make sure only contracted vendors are used.

Ability to work independently with self-initiative and discipline

Collaborates with the interdisciplinary team to assist in the implementation of the identified discharge plan.

Research for coverage or benefit questions and contract status.

Demonstrated interpersonal communication skills; ie: motivational interviewing

Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.

Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.

Coordinate internal and external resources for the individual member.

Attends meetings as needed.

Assist TOC/CCR nurses with discharge needs identified by clinical staff.

Obtain medical records/clinical information and discharge dates as needed

Process select authorizations not requiring nurse or Physician Advisor review.

Utilize HPMG resources such as guidelines and SharePoint.

Route authorizations as directed.

Oversee denial letters

Benefit verification with health plans.

Will require travel to office sites (aside from home office location) as needed for leadership meetings/staff training.

Participate in training of new employees and new processes/workflows.

Assist supervisors with ongoing/annual audits of staff and identify areas that require additional staff education

Required Experience

3+ years' managed care experience preferred

Medical terminology required.

Experience using ICD9/10 CPT coding preferred

Computer Experience: proficiency with routine applications including Microsoft Word and Excel and or web-based application

Ability to coordinate effectively with a variety of customers including: members, providers, hospital and office staff, health plans, internal departments, community resources, and peers.

Ability to work independently as well as in team environment.

Ability to interface with all levels of management.

Demonstrated project coordination skills.

Multi-tasking and ability to prioritize and problem solve through critical thinking.

Ability to contribute to cross-functional work groups both as a leader and participant.

Ability to meet strict timeframes.

Required Education

A.A. degree preferred.

Additional Information

Salary: $87,000 - $113,000 Annual

Hill Physicians is an Equal Opportunity Employer