Innovista Health logo
Innovista Health

Enabling physicians to engage, support, and manage value-based savings and shared-risk models.

Referral Coordinator

Location

Texas

Posted

5 days ago

Salary

0

Seniority

Mid Level

High School2 yrs expEnglish

Job Description

Referral Coordinator

Innovista Health

• 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.

Job 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.

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Trinity Health logo

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