Referral Coordinator

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🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Innovista Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Helping providers succeed in value-based care by developing strong relationships, delivering innovative solutions, and driving exceptional performance.

📋 Description

• 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. • Effectively communicates to management and internal departments timely. • 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. • Coordinates DME with contracted HMO vendors for outpatient services. • Coordinate with Inpatient Case Manager on discharge planning of members (DME, Home Health, and Skilled Nursing). • Coordinates and reviews retro surgical procedures with Manager. • Understands Health Plan policies and procedures regarding pre-authorization, benefits by health plan, and preferred facilities within each plan. • Enters data and coordinates elective admissions with a surgical component. • Maintains compliance with all health plan guidelines on the reporting of cases/surgeries. • Works with clinical staff to assess benefit levels for non-medical denial determination to ensure the denial process includes letter and log maintenance. • Identifies potential stop-loss candidates to be monitored and reports to a senior-level manager. • 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. • Other duties as assigned.

🎯 Requirements

• High School Diploma or equivalent experience required. • At least 2-3 years of relevant professional experience, including managed care and quality. • Being knowledgeable in using InterQual and/or MCG (Milliman) guidelines is a plus. • Able to effectively communicate technical concepts and basic business concepts with team members and internal customers.

🏖️ Benefits

• 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. • Assurance of financial security with company-paid benefits such as short and long-term disability, employee life, and Accidental Death and Dismemberment (AD&D) policies. • A yearly discretionary bonus, enhancing your financial prospects. • A generous paid time off policy that appreciates and rewards your loyalty and tenure with the company. • Paid company holidays and parental leave, ensuring time for relaxation and family. • Access to our Employee Assistance Program, supporting you in times of need. • A 401(k) scheme with a company match, supporting your future financial stability. • The opportunity for flexible work arrangements including remote or hybrid work, and potentially adjustable work hours. • Opportunities for continuous education, fostering personal growth and development. • A "Dress for Your Day" policy, promoting comfort and individuality. • Access to discounted gym memberships via medical coverage, promoting wellness and health. • Clear career advancement and growth pathways, recognizing your hard work and ambition. • Rewarding employee referral bonuses for expanding our team with like-minded individuals. • An open-door policy that encourages direct communication with our CEO and upper management, fostering transparency and inclusivity in our work culture.