Humera - Administrative and Professional Staffing

Review Coordinator I

Minnetonka, MN, United States
Contact For Rate
Feb 21, 2018
Feb 27, 2018
Job Type
Employment Status
Full Time
Humera is seeking a Transitions of Care (TOC) Review Coordinator -CTH for our client in Minnetonka, MN. The TOC (Transitions of Care) Review Coordinator is responsible for coordinating all intake functions around inpatient admission notifications and establishing initial outreach with the facility case management teams for clinical information and discharge planning. The Transitions of Care Review Coordinator utilizes an internal triage tool and a high risk diagnosis trigger list to identify those members for case management support based on a combination of factors including predictive values, likelihood of hospitalization and condition profile with pharmacy adherence. The Transitions of Care Review Coordinator creates case review modules for the assigned case management team based on triaging and identification of member's risk status. This role is a critical role as Medica moves towards a member centric in-patient review process shifting the focus to engagement, collaboration and support during the discharge planning process for the member.

Process Initiation 30%

  • Reviews inpatient admission notifications daily to initiate the transitions of care review process and establish the initial communication with the facilities care management team
  • Reviews inpatient admission notifications for appropriateness against requirements; identifies potential issues related to transitions of care requirements and communicates to key stakeholders for resolution
  • Triages and processes all incoming calls, faxes, letters, and email communications using various software applications; ensures clinical information is available to case management staff by monitoring and clearing the fax queues and email boxes timely and efficiently
  • Is responsible for first-line contact and coordination of resources to resolve provider and member concerns
  • Communicates transitions of care overviews to providers and members as needed
Administration and Process 30%

  • Acts as a resource and collaborates with the case management team daily
  • Identifies opportunities for improvement and /or enhancements in job responsibilities to ensure cases and responses are handled timely and efficiently
  • Provides thorough investigation and research on member?s clinical profiles to identify additional members or additional risks
  • Monitors open cases to obtain pertinent information and identifies discharge dates
  • Documents appropriate information in software systems based on provider and member communications and status of cases
  • Identifies issues and trends. Takes appropriate steps to resolve or bring information to leadership?s awareness
Data Systems 10%

  • Demonstrates proficiency in and knowledge of required electronic systems when processing notifications requests and clinical
  • Identifies system and processing errors. Takes ownership and appropriate steps to resolve or bring information to leadership?s awareness
Projects/Team Accountabilities 10%

  • Completes projects and assignments as directed
  • Participates on committees and/or projects as assigned
  • Attends team meetings, 1:1 meetings and performance reviews of daily work
Policy/Procedures 20%

  • Assists with development of new or revisions of existing work flows and or Standard Operating Procedures to assure accuracy
  • Completes policy reviews and trainings in a timely manner to ensure process accuracy
  • Complies with all department policies, regulatory and accreditation requirements
  • Works with leadership to keep current on changes to administrative requirements related to transitions of care and communicates trends or inconsistencies if identified

Minimum education level required to qualify for the position

  • Associate's degree in medical record technology, or equivalent experience
  • Minimum years' experience required in the field to qualify for the position: 3 years
Specific types of experience or skills required:

  • 3 years of office experience, managed care, and/or health insurance experience
  • 3 years of work experience requiring strong investigating and problem solving experience
  • 3 years of computer experience-- ability to use Word and Excel at an intermediate level and the ability to manage multiple systems/software applications
  • Knowledge and understanding of basic medical terminology
  • Ability to work independently, strong decision making skills
  • Identify and recommend individual and team process improvements
  • Ability to critically think and work effectively in a fast paced environment
  • Attention to detail and accuracy in completing multiple responsibilities within the established timeframes
  • Strong prioritization and organizational skills
  • Flexibility in handling changes in work assignments and environment
  • Excellent internal and external customer service skills

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