purchased referred care - Ganado

Only for registered members Ganado, United States

1 month ago

Default job background
Full time

Job summary

The Purchased Referred Care Specialist will provide services supporting the PRC Department and all functions within to include referrals claims non-emergent medical transportation alternate resources/patient benefits to qualified individuals in the managed health care plan administered by the Navajo Health Foundation/Sage Memorial Hospital (NHF/SMH)

This position provides support services to the Purchased Referred Care Department and all related services in maintaining a viable program that demonstrates compliance with policy and regulations.

Responsibilities
  • Review all new urgent routine and stat referrals determine eligibility based on PRC Guidelines notify patient of determination identify vendor send vendor authorization/denial form and referral packet note activity in EHR 
  • External referrals from IHS-638 facilities import referral packet into EHR by creating a new case or referrals follow eligibility guidelines to make determination notify patient of determination identify vendor send vendor authorization/denial form and referral packet note activity on the new case in EHR 

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