Referral Coordinator - Telecommute

Job Description Description: Are you searching for a fulfilling role that can make a significant difference in healthcare? At Innovista, we're devoted to driving transformative change in this essential sector. Our independent physician partners achieve exceptional results in every aspect of value-based care, contributing to enhanced patient care and improved practice outcomes. Innovista Health is a full-service management services organization with a commitment to revolutionizing practice, offering solutions like multi-payer program administration, quality, utilization, and care coordination services, as well as performance improvement insights and reporting.

This fully remote position is a fantastic opportunity for you to become a part of our team in Dallas or Houston, leading the charge toward a superior, more efficient healthcare system.

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.

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.
Coordinate with Inpatient Case Manager on discharge planning of members (DME, Home Health, and Skilled Nursing).
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.
High School Diploma or equivalent experience required.
At least 2-3 years of relevant professional experience, including managed care and quality.
Able to effectively communicate technical concepts and basic business concepts with team members and internal customers.

We understand the significance of balancing personal life with work commitments and hence offer a comprehensive benefits package to support our team. 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.
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.