Easter Seals Jobs

Job Summary:

Supports the Transplant Coordinators case management efforts through clinical data collection, referral/authorization management, accessing appointments and consultations, facilitating the communication of medical information to the providers, managing data collection for administrative purposes, and coordinating travel arrangements and reimbursements for the members.

Essential Responsibilities:

• Referral Management: Manages local regions referral review process for transplant authorizations; collects supporting documentation from available sources and presents case to reviewer per local region procedure. Anticipates leakage out of the Network and develops processes to find and correct it according to local region policy and procedure and NTN exemption process.

• Generates and ensures communication of authorizations to the referring provider, COE, member and claims unit. Collaborates with the Transplant Coordinator, and local region Utilization Management to ensure that the process fulfills all regulatory requirements. Collaborates with the claims department to ensure that claims are paid according to the appropriate contract and fee schedule.

• Educates local providers regarding the referral process for Transplant Services; develops and implements systems to ensure that 98% of referrals for Transplant Services occur within Centers of Excellence.

• Consistently supports compliance of responsibility (Kaiser Permanente code of conduct) by maintaining the privacy and confidentially of information, protecting the assets of the organization, acting with ethics and integrity, reporting non compliance, and adhering to applicable, federal, state, and local laws and regulations, accreditation, and licensure requirements (if applicable), and Kaiser Permanente policies and procedures. Performs all other duties as assigned.

• Clinical Information Management: Collects COE /Organ specific clinical information for the members with approved referrals for transplant; collaborate with the Transplant Coordinator to ensure that information is timely and complete.

• Collaborates with the Transplant Coordinator to ensure accurate and complete Hub Intake Form. Develops and implements systems for ensuring that clinical information from the COE or referring provider is received by the intended recipient in a timely and user friendly manner.

• Develops processes and implements monitors for local region in-patient census to identify case managed members that have been admitted to an in-patient facility. Collects clinical information for members approved for transplant; collaborates with transplant coordinator and physicians to ensure that information is timely and complete. Performs order entry functions as directed by transplant coordinators and clinicians.

• Collaborates with transplant coordinators to ensure that accurate information is forwarded to the COE and or retrieved from the COE. Triages requests for clinical information from COE on behalf of transplant coordinators and clinicians.

• Access to Clinical Services: Anticipates delay in processes and works to ensure members timely access to required consultations/diagnostic procedures requested by COE. Coordinates appointments for consultations/diagnostics with providers and members according to the medical indication.

• Reduces redundancy and outside costs by collaborating with the transplant coordinator to maximize repatriation of services whenever it is clinical appropriate and within the confines of the members contract with the Health Plan.

• Ensures that authorization for outside services are accurate and communicated to all effected parties. Ensures that appointments are consummated within the medically relevant timeframe and follow up expectations are clear.

• Travel Support: Receives Verification of Per Diem from Transplant Hub and ensures payment is made to member; collaborates with the Transplant Coordinator, if the member is not under Hub management, to determine if Per Diem payments are appropriate and ensure accurate payment.

• Collaborates with the Transplant Coordinator when the Hub does not manage member, to determine when out of area travel to the COE is medically necessary, and coordinates travel services in a cost-effective manner. Educates members about their local region benefits and travel support policies and procedures.

  Basic Qualifications:

  Experience

• Minimum three (3) years of experience in utilization management (required on original description).

  Education

• Bachelors degree, OR four (4) years of experience in health care administration, or related field (i.e. Clincial Transplant Care etc.).

• High School Diploma or General Education Development (GED) required.

  License, Certification, Registration

• N/A

  Additional Requirements:

• Strong problem solving and organizational skills.

• Works well in multi-tasking team environment.

• Competent in computer skills.

• Must be able to work in a Labor/Management Partnership environment.

  Preferred Qualifications:

• Minimum one (1) year of experience in an ambulatory clinical setting preferred.

COMPANY: KAISER

TITLE: Clinical Transplant Associate

LOCATION: Los Angeles, California

REQNUMBER: 1332852

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.