Referral Coordinator at Innovista Medical Center Texas LLC

United States

<p>Description</p><p>Are you searching for a fulfilling role that can make a significant difference in healthcare? At Innovista, we're devoted to driving transformative change in this essential sector. Our independent physician partners achieve exceptional results in every aspect of value-based care, contributing to enhanced patient care and improved practice outcomes. Innovista Health is a full-service management services organization with a commitment to revolutionizing practice, offering solutions like multi-payer program administration, quality, utilization, and care coordination services, as well as performance improvement insights and reporting.&nbsp;&nbsp;</p><p><br/></p><p>Innovista Health Solutions, based in Illinois, is an organization with a far-reaching influence, operating in both Illinois and Texas. At Innovista, we trust in the power of innovative programs and dedicated people to propel us forward in today's ever-changing healthcare market.&nbsp;&nbsp;</p><p>&nbsp;This fully remote position is a fantastic opportunity for you to become a part of our Houston, TX team, leading the charge toward a superior, more efficient healthcare system.&nbsp;&nbsp;</p><p><br/></p><p><br/></p><p><strong>JOB SUMMARY:</strong></p><p>Provide internal support to the Medical Management Department in the areas of Outpatient Case Management ensuring all services referred are reviewed according to plan requirements and approved criteria.</p><p>&nbsp;</p><p><strong>DUTIES AND RESPONSIBILITIES:</strong></p><ul><li>Effectively communicates to management and internal departments timely.</li><li>Receives and responds to all incoming calls from PCP, specialists, and other providers regarding inpatients, surgeries, and outpatient services including DME, Home Health Care, and other services requiring a pre-authorization.</li><li>Coordinates DME with contracted HMO vendors for outpatient services.</li><li>Coordinate with Inpatient Case Manager on discharge planning of members (DME, Home Health, and Skilled Nursing).</li><li>Coordinates and reviews retro surgical procedures with Manager.</li><li>Understands Health Plan policies and procedures regarding pre-authorization, benefits by health plan, and preferred facilities within each plan.</li><li>Enters data and coordinates elective admissions with a surgical component.</li><li>Maintains compliance with all health plan guidelines on the reporting of cases/surgeries.</li><li>Works with clinical staff to assess benefit levels for non-medical denial determination to ensure the denial process includes letter and log maintenance.</li><li>Identifies potential stop-loss candidates to be monitored and reports to a senior-level manager.</li><li>Applies Innovista guidelines and additional approved criteria as detailed in the client UM Plan for the length of stay/admission criteria to approve initial and continued inpatient services.</li><li>Other duties as assigned.</li></ul><p>Requirements</p><ul><li>High School Diploma or equivalent experience required.&nbsp;</li><li>At least 2-3 years of relevant professional experience, including managed care and quality.</li><li>Being knowledgeable in using InterQual and/or MCG (Milliman) guidelines is a plus.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</li><li>Able to effectively communicate technical concepts and basic business concepts with team members and internal customers.&nbsp;&nbsp;&nbsp;</li></ul><p><br/></p><p><u><strong>BENEFITS:</strong></u></p><p>At Innovista, we prioritize attracting talented individuals who embody our core values of integrity, determination, and teamwork. We understand the significance of balancing personal life with work commitments and hence offer a comprehensive benefits package to support our team. Our offerings include:&nbsp;</p><ul><li>A robust health benefits package with subsidized medical insurance, including Flexible Spending Account (FSA), Health Savings Account (HSA), and Health Reimbursement Account (HRA) options, complemented by dental and vision coverage.&nbsp;</li><li>Assurance of financial security with company-paid benefits such as short and long-term disability, employee life, and Accidental Death and Dismemberment (AD&amp;D) policies.&nbsp;</li><li>A yearly discretionary bonus, enhancing your financial prospects.&nbsp;</li><li>A generous paid time off policy that appreciates and rewards your loyalty and tenure with the company.&nbsp;</li><li>Paid company holidays and parental leave, ensuring time for relaxation and family.&nbsp;</li><li>Access to our Employee Assistance Program, supporting you in times of need.&nbsp;</li><li>A 401(k) scheme with a company match, supporting your future financial stability.&nbsp;</li><li>The opportunity for flexible work arrangements including remote or hybrid work, and potentially adjustable work hours.&nbsp;</li><li>Opportunities for continuous education, fostering personal growth and development.&nbsp;</li><li>A "Dress for Your Day" policy, promoting comfort and individuality.&nbsp;</li><li>Access to discounted gym memberships via medical coverage, promoting wellness and health.&nbsp;</li><li>Clear career advancement and growth pathways, recognizing your hard work and ambition.&nbsp;</li><li>Rewarding employee referral bonuses for expanding our team with like-minded individuals.&nbsp;</li><li>An open-door policy that encourages direct communication with our CEO and upper management, fostering transparency and inclusivity in our work culture.&nbsp;</li></ul><p><br/></p>