Care Specialist - Inpatient
Job ID: 104665 Date posted: September 04, 2020
- SRS Administration
- Inpatient Case Management
- Clerical Jobs
- Day Job
- Per Diem
The Care Specialist will coordinate referrals for medical care and services, including requests for outpatient care, elective inpatient admission and skilled nursing facility admission, medical equipment, home health, and prescription authorization in accordance with Sharp Rees-Stealy Medical Group (SRS) referral guidelines. To provide support and facilitation of care coordination services provided by the Case Managers to members.
Obtain benefit coverage for plan members
Check eligibility status
Investigate and follow-up on all eligibility issues in accordance with health plan and SRS guidelines
Coordinate and process referrals for SRS Inpatient patients
Obtains necessary medical information by following the SRS inpatient processes and utilize designated computer applications.
Research and assist in the appeal process
Obtain and gather clinical information from multiple sources
Maintain and organize data, prepare and distribute reports
Manage correspondence to members and PCP, health plan, and other providers
Make phone calls to members, physician offices, health plans, and providers to assist in care coordination
Organize and maintain case files
Provide clerical support and assistance to the Case Management team
Completion of daily EA census, spreadsheet tracking, email notifications, office supply monitoring
Sharp Rees-Stealy's mission is to improve the health of its community through a caring partnership of patients, physicians and employees. Its goal is to offer quality services that set community standards and exceed expectations in a caring, convenient, affordable and accessible manner.
Sharp Rees-Stealy has been serving the health care needs of San Diegans since 1923 when doctors Clarence Rees and Clair Stealy formed San Diego's first multispecialty medical group practice. Today, Sharp Rees-Stealy has 21 locations and 450 primary care doctors and specialists representing virtually every field of medicine.
Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.
This position will float to Sharp Memorial Hospital, Sharp Grossmont Hospital and Sharp Chula Vista Medical Center in San Diego County
Per Diem, Days - Variable Shifts
Required Skills and Qualifications
- 3 years minimum working in the health care field, preferably HMO or acute care
- 1 year experience with medical coding & data entry, preferred * Excellent organization& time management skills
- Ability to multi-task; excellent analytical & problem solving skills
- Proficient in medical terminology & current standards of clinical practice
- Proficient in use of ICD-10, CPT & HCPC coding
- Proficient in typing and computer data entry
- Excellent verbal & written communication skills
- Ability to read, speak & hear English clearly
- Ability to work independently in research & decision making with minimal direction
- Computer knowledge, prefer experience with MS Word, MS Excel, and MS Office
Preferred Skills and Qualifications
- Successful completion of Medical Assistant Program
“After nearly 10 years of working here, it's still one of the hardest jobs I've ever loved. If you find a niche here, you'll be working with some of the smartest in the industry. This is where they'll respect you for thinking outside the box and kindness matters. They expect consistency and hard work, but pay you well to do it.”