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Lead Care Coordinator

Job ID 81748 Date posted 10/03/2017
  • Facility: Sharp HealthCare
  • City: San Diego
  • Department: SCMG Utilization Management
  • Category: Business Operations Jobs
  • Job Status: Full-Time
  • Shift: Day Job
  • FTE: 1.0
  • Shift Start: 7 AM
  • Shift End Time: 4:30 PM


This position is located in Kearny Mesa, San Diego County



8 hour day shift,  7:00am-4:30pm- Float Position


Required Skills and Qualifications

  • High School diploma
  • 3-5 years working in the managed health care field, preferably HMO or delegated risk medical group/IPA setting.
  • 3 years experience with medical coding and data entry, preferably in a managed care environment
  • Successful completion of ICD-9 and CPT coding classes, or equivalent work experience
  • Demonstrated leadership experience and/or special projects motivating a group of people
  • Demonstrates ability to lead day-to-day operations of the Care Coordinator and Medical Record Coordination teams
  • Excellent organizational and time management skills, ability to multitask and excellent analytical, problem solving skills
  • Excellent knowledge of Utilization Management, HMO benefits, covered services, billing and reimbursement procedures of all payor types
  • Proficient in medical terminology and current standards of clinical practice
  • Ability to contribute creative and innovative ideas to help achieve the goals and
  • objectives of the SCMG UM Programs and Work Plans
  • Working knowledge of IDX Managed Care Applications including OnBAse and
  • Referral Queue Manager, HMO contracts, Medicare, SCMG and Health Plan regulatory guidelines
  • Proficient in use of ICD-9, CPT4 and HCPC coding systems
  • Proficient in typing and computer data entry (45 wpm)
  • Excellent verbal and written communication skills
  • Ability to read, speak and hear English clearly
  • Ability to work independently in research and decision making with minimal direction from higher level staff
  • Occasional travel between Sharp HealthCare facilities and provider offices; must provide own transportation


Preferred Skills and Qualifications

  • Supervisory experience
  • Successful completion of Medical Assistant program or equivalent


Under the direction of the Care Coordinator Supervisors, provide oversight and leadership to the Care Coordinator staff and to review requests for medical care and services that includes requests for outpatient care, elective inpatient admission and skilled nursing facility admission, retrospective claim review, medical equipment, and home health in accordance with Sharp Community Medical Group (SCMG) referral guidelines. Also provides oversight of Medical Record Coordination team ensuring efficient, accurate and timely workflow of electronic records are consistently maintained. To provide support and facilitation of care coordination/medical record coordination services provided by the Care Managers to members. Represents the Care Coordinator/Medical record Coordination Staff in departmental leadership meetings. Active participation in Continuous Quality Improvement meetings by contributing creative and innovative ideas to enhance Utilization Management processes (e.g., Authorization Guideline Development and other ad hoc teams working on quality improvement projects).

This is a "float" position and is responsible for coverage at all levels of Care Coordination and Medical Record Coordination. This person will cover for staff PTO, other absences and situations as necessary, and serve as a knowledgeable resource to all customers served, including but not limited to Customer Service and Health Services Management.

Departments.Sharp Community Medical Group (SCMG) is one of the state's largest and most successful IPAs. Established in 1989, it has over 140,000 members and is comprised of 200 primary care physicians and 500 specialists. The Health Services division of SCMG coordinates the medical care of members for inpatient and outpatient services and has a staff of 80 nurses, coordinators and support personnel to manage utilization review, case management and quality improvement functions. Sharp Community doctors admit to all Sharp hospitals and Rady Children’s Hospital. In addition, Sharp Community patients have access to urgent care centers throughout the county.

Additional Physical Requirements will be discussed during the interview

Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.

Keywords: IDX, Managed care, ICD-9, HCPC coding, HMO benefits

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