Concurrent Review Cooridnators
Company: NTT DATA
Location: San Francisco
Posted on: May 28, 2023
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
- 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
- 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
- Maintain designated databases as needed for reporting
- 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
- One year of experience in a customer service, call center
- 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
- 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 -nttdata.com 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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