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Company: Network Medical Management Inc
Location: Monterey Park
Posted on: January 13, 2022

Job Description:

SUMMARYAssist Ambulatory Care Management Nurse with the day-to-day care management responsibilities; to efficient and effective ambulatory care management to eligible population.

  • Complies with NMM and department policies & procedures to ensure all appropriate assessment for the eligible population are completed and acted upon within established timeframes.
    • Assist Ambulatory Care Management Nurse with day-to-day activities.
    • Responsible for data collection to assist ACM nurse with assessment and care plan implementation but not limited to:
      • Eligibility verification
      • Create member chart
      • Health plan portal data download (HRA, Member profile, etc.)
      • Authorization/Claim history
      • Request medical records from physicians for review.
      • Create case (EZ-Cap/EZ-Care)
      • Case load: Minimum 10 per day.
        • Responsible for member/provider notification (telephonic and/or written) utilizing department templates.
        • Scan and file any applicable information to appropriate folders.
        • Scan and file returned member mailings to appropriate folders.
        • Notify ACM Nurse any change in members' status (unable to reach, opt-out, agree to join)
        • Responsible for follow-up call and returning department calls.
        • Participates in all health plan and department meetings and trainings as applicable.
        • Assist with health plan audit preparation.
          • Maintains strictest confidentiality at all times.
          • Performs other duties, projects and actions as assigned
            • High School Graduate or equivalent
            • Experienced in managed care environment to include but not limited to health plan, IPA or MSO preferred.
            • Knowledge of medical terminology, ICD-9, ICD-10, CPT codes.
            • Proficient with Microsoft Office (Word, Excel, Power Point) and EZCAP
            • Good organizational skills.
            • Excellent written and oral communication skills, as well as strong interpersonal, critical thinking and analytical skills.
            • Must have the ability to multitask and problem solve in a fast pace work environment
              • Personal & Professional Qualities
                • Punctuality, detail oriented, creativity, etc. would be helpful for this position
                • Ability to follow directions and perform work independently according to department standards
                • Able to function effectively under time constraint
                • Able to maintain confidentiality at all times
                • Willingness to accept responsibility and desire to learn new task
                • Must be a strong team player, punctual and have excellent attendance record.

Keywords: Network Medical Management Inc, Monterey Park , AMBULATORY CARE COORDINATOR, Other , Monterey Park, California

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