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Clinical Transplant AssociateLocation: Los Angeles, CA Additional Locations:
Job Number: 768376 Date posted: 02/09/2019
***Transplant Experience Preferred***
Supports the Transplant Coordinator's case management efforts through clinical data collection, referral/authorization management, accessing appointments & consultations, facilitating the communication of medical information to the providers, managing data collection for administrative purposes, & coordinating travel arrangements & reimbursements for the members.
- Referral Management: Manages local regions referral review process for transplant authorizations; collects supporting documentation from available sources & presents case to reviewer per local region procedure. Anticipates leakage out of the Network & develops processes to find & correct it according to local region policy & procedure & NTN exemption process.
- Generates & ensures communication of authorizations to the referring provider, COE, member & claims unit. Collaborates w/ the Transplant Coordinator, & local region Utilization Management to ensure that the process fulfills all regulatory requirements. Collaborates w/ the claims department to ensure that claims are paid according to the appropriate contract & fee schedule.
- Educates local providers regarding the referral process for Transplant Services; develops & implements systems to ensure that 98% of referrals for Transplant Services occur w/in Centers of Excellence.
- Consistently supports compliance of responsibility (Kaiser Permanente code of conduct) by maintaining the privacy & confidentially of information, protecting the assets of the organization, acting w/ ethics & integrity, reporting non compliance, & adhering to applicable, federal, state, & local laws & regulations, accreditation, & licensure requirements (if applicable), & Kaiser Permanente policies & procedures. Performs all other duties as assigned.
- Clinical Information Management: Collects COE /Organ specific clinical information for the members w/ approved referrals for transplant; collaborate w/ the Transplant Coordinator to ensure that information is timely & complete.
- Collaborates w/ the Transplant Coordinator to ensure accurate & complete Hub Intake Form. Develops & implements systems for ensuring that clinical information from the COE or referring provider is received by the intended recipient in a timely & user friendly manner.
- Develops processes & 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 w/ transplant coordinator & physicians to ensure that information is timely & complete. Performs order entry functions as directed by transplant coordinators & clinicians.
- Collaborates w/ transplant coordinators to ensure that accurate information is forwarded to the COE & or retrieved from the COE. Triages requests for clinical information from COE on behalf of transplant coordinators & clinicians.
- Access to Clinical Services: Anticipates delay in processes & works to ensure members' timely access to required consultations/diagnostic procedures requested by COE. Coordinates appointments for consultations/diagnostics w/ providers & members according to the medical indication.
- Reduces redundancy & outside costs by collaborating w/ the transplant coordinator to maximize repatriation of services whenever it is clinical appropriate & w/in the confines of the members contract w/ the Health Plan.
- Ensures that authorization for outside services are accurate & communicated to all effected parties.
- This job description is not all encompassing.
- Minimum three (3) years of experience in utilization management (required on original description).
- Bachelor's 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
- 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.
- Minimum one (1) year of experience in an ambulatory clinical setting preferred.
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 and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
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