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Concurrent Review Cooridnators

Company: NTT DATA
Location: San Francisco
Posted on: May 28, 2023

Job Description:

NTT Data is assisting our Healthcare client in their recruiting efforts for this role. - This is a temporary position with possibilty of going permanent. -LOCATION: REMOTEDURATION: 4 months. Potential exists for the project to run longer and perhaps convert. PAY RATE: - $28/hourEQUIPMENT: NTT will provideJOB DESCRIPTION:The Concurrent Review & Care Transitions 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.Candidate should have excellent customer service, organization and interpersonal communication skills. They should also take pride in exemplary teamwork and possess a positive attitude.WHAT YOU WILL DO

  • Research utilization management requests using a variety of resources including SFHP 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 SFHP's policies and procedures relating to HIPAA compliance.
  • Maintain an accurate census of SFHP 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.WHAT YOU WILL BRING
    • One year of experience with state and federal insurance programs.
    • One year of experience in a customer service, call center setting.
    • A Bachelor's degree in Health, Social or Life Sciences, Business or a related field.
    • PC literacy and demonstrated proficiency with MSOffice (Outlook, Word, Excel, PowerPoint)
    • 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.About NTT DATA Services: NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global -innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications -development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit or LinkedIn to learn more. NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, -gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and -inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate -team. Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $80.00 to $90.00. This range reflects the -minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on -a number of -factors, including the candidate's actual work -location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance.

Keywords: NTT DATA, San Francisco , Concurrent Review Cooridnators, Other , San Francisco, California

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