Provides timely and high quality administrative and/or project support for the Departments of QRM with dedicated support to the following areas: (1) Readmission / Transitional Care team and the Specialty Review Team (2) Obtains hospital discharge summaries for core and non – core hospitals (3) Post discharge calls to members. Responsibilities may include answering phones and relaying messages/information to both departmental staff and callers; scheduling patient appointments; maintaining filing systems; data entry; opening/sorting mail. Requesting clinical info from Noncore, SNF/Rehab facilities to ensure timely concurrent review, assist in arranging non-urgent transportation for members in SNF/Rehab facilities.
This description is for recruitment posting purposes only. It has not received full HR review and approval.
- Obtains Hospital Discharge Summaries and sends to medical records to be filed in members electronic medical record.
- Provides support to the Telephonic Inpatient Care Coordinators, the SNF/Rehab Care Coordinators and the Transitional Case Manager as outlined above.
- Responsible for the concurrent review right fax pool.
- Responsible for the generation of NONC and denial letters with proofing done by the General Review Supervisor.
- Schedules follow up appointments for members upon request.
- Maintains a filing system for copies of all NONC and denial letters for utilization review and quality assurance purposes.
- Maintain Transplant Log/files and obtains the check for transplant members.
- Provides administrative duties such as typing correspondence and answering telephones on a as needed basis for the QRM department.
- Remains knowledgeable of contract benefits and current, relevant state and Federal regulations.
- Maintains effective interaction/communication with members of the medical staff, nursing staff, other QRM staff, and Kaiser Permanente medical offices.
- Builds effective working relationships with physicians/staff, QRM staff, and other departments within the health plan.
- Identifies and reports problems and inefficiencies in existing systems, and recommends changes when appropriate.
- Maintains member confidentiality.
- Supports QRM Management team.
- Assists with telephone pound-out calls for the Transitional Case Review and General Review Nurses.
- Type’s letters, memos, minutes and reports utilizing word processing equipment.
- Makes copies and distributes accordingly.
- Assists with mass mailings and special projects to include making copies, collecting materials and distribution of same.
- Assumes responsibilities of the QRM Administrative Coordinator their absence.
- Performs related miscellaneous duties as required by the position and as directed by the directors of Provider Contracting and QRM.