Job Description

Job Description

Job Description

Summary

The Transplant Care Coordinator is responsible for overseeing the coordination of care for transplant candidates. The position is responsible for maintaining departmental policies and workflows as they relate to timely access to care. Reports directly to the Outpatient Lead Coordinator under the guidance of the Supervisor.

Duties and Responsibilities

· Process referral requests for organ transplant initial evaluation and related services

· Verify member eligibility and Health Plan contracted Center of Excellence

· Maintain knowledge of the State of California’s Center of Excellence for organ transplant services

· Coordinate members care to ensure member and provider satisfaction

· Assures that sent requests are complete with all necessary clinical and member information required for review

· Assures that requests adhere to CMS and DMHC regulations for timeliness standards

· Contacts provider offices for additional member information, as needed

· Outreach to Health Plans for updates on outstanding requests

· Outreach to Center of Excellence for status on members status

· Updates authorization status and documents Health Plan decisions in EZ CAP database

· Outreach to members to assist with appointment schedules

· Collaborate with leadership on complex cases

· Read and maintain email inquiries

· Assists the Client Support Center with a high volume of calls, as needed

· Assists other team members with their workload, as needed

· Regular attendance at UM team meetings

· Assist in UM special projects

Minimum Job Requirements

· High School graduate or GED equivalent

· 1 year of experience in managed care

· Knowledge of medical terminology

· Fluency in both English and Spanish

· Proficiency in Microsoft Office programs, especially Word and Excel

· Proficiency in EZ CAP a plus

Skill and Abilities

· Ability to multi-task while remaining adaptable and flexible to fast-paced environment

· Reliable, dependable, and accountable

· Strong customer service skills with good telephone rapport

· Ability to empathize with complex cases

· Self-Motivation and ability to work effectively in an independent environment

· Great critical thinking and problem-solving skills

Job Tags

Similar Jobs