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Chula Vista

    IHA Outreach Specialist - Chula Vista, United States - Community Health Group

    Community Health Group
    Community Health Group Chula Vista, United States

    2 weeks ago

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    Description

    POSITION SUMMARY
    Promotes timely and appropriate scheduling of IHAs for Medicare Advantage Organizations (MAO)and Special Needs Plan (SNP) members. Demonstrates experience in working directly with elder and disabled populations and providers in coordinating care and services.

    Demonstrates the ability to collect information and communicate with other members of the health care team in an efficient and expedient manner.


    COMPLIANCE WITH REGULATIONS:


    Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, and Special Needs Plan (SNP).


    RESPONSIBILITIES

    • Works with members and designated providers on the scheduling and coordinating Initial Health Assessments and Home Safety Evaluations.
    • Obtains sufficient information from members, physicians and/or other health care providers to assist and facilitate coordination of care and services. Works closely with the clinical staff to ensure member communicated information is transmitted timely, care and services are coordinated as directed, established protocols are followed, and that follow up is timely.
    • Conducts or participates in the following activities: coordination and arrangement of care and services, including transportation and assistance with provider appointments, placement of monthly or quarterly status calls, and annual follow-up assessments.
    • Maintains accurate records as per established procedures. Reviews all documents received as applicable for completeness. Ensures confidentiality of all hard copy, electronic, and verbal communication, and adhere to all policies related to privacy and disclosure.
    • Keeps electronic files of IHA appointments, receives and distributes completed IHA reports to health care services team and scans information into appropriate database.
    • Works with Health Care Services, Member Services, and providers to educate members on their health care options and services available through community-based organizations.
    • Assists with entering critical points for care management into the appropriate information systems and communicates appropriate data with key staff to accomplish goals for care management plans.
    • Alerts appropriate staff of missed or rejected IHA appointments and follows up to re-schedule IHA as needed.
    • Documents all member communications by entering a summary of the member's concern, options offered for resolution, and any other relevant information into the identified systems.
    • Contributes to the team effort by attending department meetings; giving and receiving feedback; accomplishing related results as needed; assisting clinical staff in identifying areas requiring policies and procedures; working with clinical staff in policy development and periodic policy review.
    • Maintains filing system by maintaining accurate files of IHA schedules and documentation needed to complete IHA process; retrieves and/or reproduced files as needed; transfers and archives documents per department protocols.
    • Maintains product and company reputation and contributes to the team effort by conveying a professional image and accomplishing related tasks; participates on committees and in meetings; performing other duties as assigned or requested.
    Qualifications


    Education:

    • High school diploma or equivalent.
    • Medical terminology.
    • Associates degree in medical field preferred.

    Experience/Skills:

    • 2 years customer service and data entry experience in medical field.
    • 3 years customer service and data entry experience in a managed care organization preferred.
    • Ability to operate a personal computer, UM/CM System/HSD database, telephone, fax, and copier.
    • Medical terminology including ICD10 & CPT coding structures.
    • Excellent customer service and communication skills.
    • Detail-oriented.
    • Bilingual (English/Spanish) required.

    Physical Requirements:

    • Prolonged sitting, data entry and telephone use.
    • May be required to work evenings and/or weekends.
    Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws.

    This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings.

    Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action
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