SNF Coordinator

Skilled Nursing Facility Care Coordinator

This position supports skilled nursing admissions, concurrent review, and discharge planning. The Skilled Nursing Facility Care Coordinator ensures the SNF management process runs smoothly by providing timely information to the RMG and LCH administrative management team, Skilled Nursing Physicians, and care managers.

Responsibilities include completing all clerical functions accurately and on time from admission through discharge, including required follow-up care. The role also assists in facilitating the provision of required patient information to the skilled nursing facility and supports the SNF Case Manager.

Essential Duties and Responsibilities include the following:

• Communicate daily with Care Management Nurses regarding member status, eligibility, benefits, authorizations, and care coordination needs.
• Summarize overnight admissions and provide updates to the clinical team by 10:00 a.m. each business day.
• Check member eligibility and benefits for all admissions and communicate findings to Care Management staff.
• Direct calls and inquiries to the appropriate physicians, providers, and internal departments.
• Communicate potential operational, clinical, or authorization issues to management on a daily basis.
• Serve as a liaison among SNFs, hospitals, providers, vendors, Medical Directors, and health plan departments.
• Immediately communicate admissions to non-contracted/non-core facilities to the Medical Director or Director of Clinical Operations.
• Process LOAs as needed
• Prepare, track, and distribute all required regulatory correspondence, including approval, denial, modification, extension, and closure letters in accordance with Health plan, CMS, DHCS, NCQA, and regulatory requirements.
• Maintain accurate documentation of all regulatory notices and correspondence in the appropriate systems.
• Ensure letters are completed within regulatory turnaround time requirements.
• Coordinate with Care Managers, Director of Clinical Operations, and Utilization Management staff to obtain information necessary for regulatory communications.
• Monitor and follow up on outstanding correspondence to ensure compliance standards are met.
• Coordinate and process authorizations for the following including but not limited to: Home Health services, Durable Medical Equipment (DME), Hospice services, Follow-up appointments, Ancillary services and Ambulatory services
• Process discharge-related authorizations as directed by the Care Management Nurse.
• Fax approved authorizations to facilities, providers, and vendors as required.
• Assist SNF Care Managers with discharge planning activities and coordination of post-discharge services.
• Schedule follow-up appointments and arrange authorized services needed upon discharge.
• Coordinate transition-of-care services to ensure continuity of medically necessary care.
• Communicate identified post-discharge needs to High Risk, Complex Case Management, and Special Needs Program departments.
• Support safe and effective transitions from SNF to home, community-based services, or alternate levels of care.
• Review case statuses regularly to ensure complete and accurate documentation
• Collaborate with assigned Care Managers to facilitate timely case completion and closure.
• File closed cases and maintain records in accordance with departmental policies.
• Fax and request facility documentation, including History & Physicals, discharge summaries, and other required records, to Primary Care Physicians and other providers.
• Maintain confidentiality of all patient, clinical, and protected health information in compliance with HIPAA and organizational policies.
• Performs other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $25/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and/or Experience:

• High school graduate required; Associate in Arts degree preferred.
• Knowledge of Healthcare and Managed Care preferred.
• Typing 60 words per minute with accuracy.
• Knowledge of computers, faxes, printers, and all other equipment.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point).
• Ability to deal with responsibility in confidential matters.
• Ability to work in a multi-task, high stress environment.
• Ability to address problems involving several concrete variables in standardized situations.
• Knowledge of medical terminology, ICD-9, and HCPCS coding.
• Strong phone etiquette required.