Clinical Resource Coordinator - Sharp Tri-City - Full-Time - Day Shift at Sharp Healthcare

Job description

Hours : Shift Start Time: 8:30 AM Shift End Time: 5 PM AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: As Needed On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $25.000 - $27.660 - $32.740 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. What You Will Do This position supports case management/social work staff to meet department objectives, facilitate effective communication between department staff and the internal and external customers to the department, including but not limited to the business office, revenue cycle, payors, long term care, sub-acute facilities, and patients/families. Reviews complex request for medical care and services, if part of the discharge plan, inpatient admission, skilled nursing facility admission, including requests for outpatient care, retrospective claim review, durable medical equipment, medication issues and acquisition, home health, in accordance with payer guidelines. To provide support and help facilitate care coordination services provided by the Hospital Case Manager. This position is responsible for the care and services delivered to a specific hospital. Required Qualifications H.S. Diploma or Equivalent Preferred Qualifications Other : Additional health related education. Other : Successful completion of Medical Assistant Program or equivalent 2 Years hospital experience. 2 Years Medi-Cal experience. Essential Functions This position supports case management/social work staff to meet department objectives, facilitate effective communication between department staff and the internal and external customers to the department, including but not limited to the business office, revenue cycle, payors, long term care, sub-acute facilities, and patients/families. Reviews complex request for medical care and services, if part of the discharge plan, inpatient admission, skilled nursing facility admission, including requests for outpatient care, retrospective claim review, durable medical equipment, medication issues and acquisition, home health, in accordance with payer guidelines. To provide support and help facilitate care coordination services provided by the Hospital Case Manager. This position is responsible for the care and services delivered to a specific hospital. Collaboration of Clinical Resources o Prepares the inpatient census. Confirms report accuracy, makes modification as warranted to reflect accurate and current information. o Verifies current insurance plan eligibility. Reports statistics to the Director of Case Management. o Prepares paperwork for the Hospital Case Managers. o Reviews patient list and prioritize/plan for the day. o Generates phone calls to physician offices, health plans, and providers to assist in care coordination under the guidance of case managers including reviewing patient's need and condition with Skilled Nursing Facilities and Home Health Agencies for placement. o Contributes to the continuous improvement initiatives of the hospital case management team to deliver quality interventions in a timely manner. o Deliver IMFM letter to patient in accordance with hospital policy and procedure. o Assist the Hospital Case Manager by relaying information regarding patient demographics and the distribution of lists of contracted facilities for Skilled Nursing. o Maintains current communications with insurance and case managers. o Maintains current phone message log of payor phone calls. o Initiates and proactively collaborates with staff regarding frequently utilized community resources. o Acts as facilitator between payors and case manager