Remote Concurrent Review Coordinator

NTT DATA Services is currently seeking a REMOTE Concurrent Review Coordinator to join our team.

JOB DESCRIPTION:

The Concurrent Review Coordinator is responsible for working with a multi-disciplinary team, serving primarily in an administrative support capacity. Primary focuses of this position include data collection, authorization management, correspondence compliance, discharge planning, and overall support of the CCR/CT team's functions. The Concurrent Review & Care Transitions Coordinator also serves as communication liaison with members, clinics, hospitals, and community partners to support care transitions efforts from inpatient to outpatient settings. The position provides opportunities to work on various projects and authorization requests within utilization management and clinical operations, contingent upon departmental needs.

• Research utilization management requests using a variety of resources including evidence of coverage, policies and procedures, and electronic resources.
• Compile data for utilization management review and submit the data to the Concurrent Review & Care Transitions nurse team for clinical decision-making.
• Maintain ongoing tracking and appropriate documentation to facilitate the determination process within the regulatory timeframes for standard and urgent authorization requests.
• Assist in discharge planning efforts for members requiring post discharge follow-up care through telephonic coordination with primary care providers.
• Provide administrative and clerical support for utilization management activities.
• Communicate effectively and timely to answer questions and resolve issues pertaining to providers, office staff, and delegated groups about authorization requests and determinations.
• Respond to calls, emails, and other inquiries regarding the status of outstanding clinical requests and utilization management processes. Ensure the privacy and security of PHI (Protected Health Information) as outlined in our policies and procedures relating to HIPAA compliance.
• Maintain an accurate census of our members.
• Work closely with providers to obtain accurate information regarding authorization requests.
• Ensure correspondence distribution compliance by working closely with designated clinicians to generate Notice of Action (NOA) letters for the requesting providers and members.
• Utilize and operate multiple software applications systems. Enters required data in various computer programs and databases.
• Maintain designated databases as needed for reporting requirements.
• Coordinate activities with the other members of the Clinical Operations Management departments and the company.
• Participate in making member phone calls working from a script and identifying when calls need to be referred to a clinician for review.

• 1+ year of experience with state and federal insurance programs.
• 1+ year of experience in customer service, call center setting.
• 2+ years of proficiency with MSOffice (Outlook, Word, Excel, PowerPoint)
• Bachelor's degree in health, Social or Life Sciences, Business, or a related field.

• Experience in an HMO or experience in a managed care setting preferred.
• Current California Medical Assistant Certification or California Pharmacy Technician License without restriction or equivalent experience in a health care field with familiarity with medical terminology and concepts, preferred.
• Experience with Medi-Cal and/or Department of Health Care Services regulations and standards preferred.
• Detail-oriented with problem-solving abilities.
• Knowledge and application of English grammar including composition, editing, and proofreading skills.
• Strong organization, time management and project management skills and multi-tasking abilities.
• Ability to handle detailed work, work with varying types of data and maintain confidentiality.
• Ability to display a courteous, patient, and helpful attitude toward internal and external stakeholders.
• Excellent customer service, organization, and interpersonal communication skills.
• pride in exemplary teamwork and possess a positive attitude.