Description
POSITION DESCRIPTION
POSITION: Patient Care Referral Coordinator
DEPARTMENT: Primary Care
REPORTS TO: Director of Compliance and Risk Management
TYPE: Full Time
Summary:
Under the direct supervision of the Clinical Health Director the Patient Care Referral Coordinator will manage the health center's referral and authorization process for all health center patients.
Responsibilities
50% Direct Patient Services
- Ensure accurate and complete referral/admission and patient tracking information by initiating and following up on all internal and external referrals on behalf of the Health Centers patients.
- Serve as an Ombudsman for the Health Centers patients and MCO's or HMO's regarding access to non-primary care services and coordinating the appeals process for denied services.
50 % Administrative Duties
- Keep detailed, accurate and complete records of referral activities to ensure appropriate visit frequencies as required for each payer per discipline.
- Review utilization and referral reports from all payors, identifying trends and patterns to management and coordinating the distribution of such reports to identified stakeholders.
- Maintain and make available to MCHC providers documented referral protocols, policies and procedures for all contracted MCO's and HMO's.
- Participate in the Health Centers outreach and education activities geared towards attracting new members and retaining current membership.
- Performs other related responsibilities as assigned.
Accountability:
Position reports to the Director of Compliance and Risk Management
High School graduate with a minimum of two years case management and referral experience.
Demonstrated knowledge of health care principles and philosophies.
Excellent communications and organizational skills are a must. Strong interpersonal skills and professional attitude. Word processing and database skills are preferred.
PI28b954d38bf5-36205-35349901
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