Metairie, Louisiana
Referral Coordinator ( FLOATER ) Job Opening in Metairie, Louisiana - The Care Coordinator will work with Care Center of Excellence, Physician Management Resources (PMR), market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management in JenCare Medical Centers.
Responsibilities:
Daily review of approved and pended outpatient requests for PMR clients and JenCare Markets.
Provide insights to the PMR team and Network Director and work with them to take action
Facilitate a daily process to help redirect poorly supported requests by: Providing feedback to Humana, Careplus, Wellcare and Coventry and working through daily authorization requests when information is missing.
Create process for managing requests when patients need to see the primary care provider by coordinating with primary care provider and Market leaders.
Enable a member of PMR network or clinical team to reach out to authorization requester when deemed necessary
Other responsibilities may include: Drive the current utilization management model to a sustainable and reproducible one dependent on market needs.
Travel as needed to PMR and JenCare markets for training and support.
Skills / Qualifications:
Excellent analytical skills in order to solve the complex and logistical problems.
Strong communication and interpersonal skills, both written and verbal, as well as delivery skills for presentations and training.
Excellent organizational skills with ability to effectively manage multiple tasks and responsibilities.
Ability to deliver efficient, high quality results within tight deadlines
Works well independently and within a team
Excellent influencing and negotiation skills.
Ability to explain complicated financial terms and utilization data to physicians/staff.
Ability to understand, interpret and communicate all types of provider, regulatory contracts and utilization management data.
Fluent in English.
Requirements:
Bachelor's degree.3+ years Utilization Management and/or Provider Relations or Healthcare Analyst experience or similar background.
Advanced MS Word and Excel.
The ability to establish credibility quickly and the willingness to take a strong approach to leadership.
An understanding of the communities that ChenMed and PMR serves, including the complexities of Medicare programs to patients in the current healthcare marketplace.
This position is requiring the candidate be flexible to travel to our other medical centers in the following areas:
Kenner
Metairie
New Orleans
Gretna
Job Type: Full-time
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