Functions as a team member working telephonically in collaboration with the ACC Clinician to ensure receipt of clinical information and appropriate discharge planning.
Competencies, Skills, and Attributes:
- Screens all inpatient admissions to determine what needs to be referred to ACC Clinician
- Requests clinical information from facilities according to workflow (SPAD/POC) and updates authorization in documentation system per workflow, sending letters as appropriate.
- Ensures that reminder is sent to ACC Clinician for review on the appropriate day.
- Refer for RC2 Upgrade and High Cost referrals as appropriate or as directed by ACC Clinician
- Refer to CM any member that meets the established guidelines as directed by ACC Clinician
- Requests discharge dates from facilities according to workflow
- Track and report to Public Partnerships Mass Health members in long term care according to Mass Health guidelines.
- Initiate discharge planning for specific diagnoses/conditions per workflow.
- Regular and reliable attendance is an essential function of the position.
Working Conditions and Physical Effort:
- Bi-lingual preferred.
- Strong customer service skills and diplomacy skills.
- Strong oral, listening, interviewing, interpersonal, written, and verbal communication skills; the ability to interact and work successfully with internal and external colleagues.
- Ability to effectively prioritize and manage multiple tasks in a fast-paced environment.
- Ability to prioritize work when processing referrals and authorization requests per guidelines and within specific Turn Around Timeframes.
- Ability to process high volumes of requests with a 95% or greater accuracy rate.
- Competency with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications.
- Fast paced, call center environment
- Ability to work OT if required
Boston Medical Center HealthNet Plan - 9 months ago