ACC Medical Specialist
BMC HealthNet Plan - Massachusetts

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Job Description Functions as a team member working telephonically in collaboration with the ACC Clinician to ensure receipt of clinical information and appropriate discharge planning.

Key Functions/Responsibilities:
  • 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.
Competencies, Skills, and Attributes:
  • 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.
Working Conditions and Physical Effort:
  • Fast paced, call center environment
  • Ability to work OT if required

Boston Medical Center HealthNet Plan - 17 months ago - save job - block
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