Dignity Health Inpatient Clerk in Bakersfield, California
The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Provides support for the Clinical Services Department, including Outpatient Case Managers, Social Services team, and Health Education, specifically through the coordination of services within the DHMSO/Dignity Health CCC and DHMSO Case Management program. Serves as intake coordinator for referrals into disease management program(s), coordinating requests for services, monitoring members, and reporting findings. Facilitates communication between providers, DHMSO staff, hospital physicians, patients and their families with regard to coordination of services.
EDUCATION & EXPERIENCE
Successful completion of medical assisting program (CMA) from an approved educational facility or
Two or more years’ experience in a clerical position within medical office, insurance or other relevant setting preferred.
JOB KNOWLEDGE, SKILLS & ABILITIES
Knowledge and understanding of IPAs, PPOs, and HMOs with regard to benefits, policies and procedures, documentation requirements and medical terminology.
Must have strong oral and written communication skills as well as organizational and project management skills.
Computer experience required with familiarity with QNXT, MS Windows (Word and Excel), NextGen and Cerner applications preferred.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Responsible for meeting all of the DHMSO Job Standards described below.
Contacts members who are identified as appropriate for medical management program(s). Explains process for telephonic management to members and obtains member consent to participate. Communicates via phone with members participating in the program(s). Contacts program participants at regular intervals to evaluate health status according to program protocol. Reports variances to nursing staff assigned to the patient. Confirms medications currently taken by member during each call. May communicate obtained information to PCP, Home Visit Program MD or DHMSO Clinical Programs MD as directed.
Documents all contacts pertaining to assigned members in PCM. Utilizes e-mail communication to insure that all appropriate staff are kept informed of relevant issues. Functions as a resource for access into Cerner for Comprehensive Care and Case Management teams. Maintains accurate records of referrals, appointments, evaluation and management process for the management process for the DHMSO/Dignity Health CCC and HH program
Processes referral requests according to company policy. Responsible for insuring all authorizations are received by the appropriate parties. Responsible for faxing clinical information, orders and authorizations generated by the DHMSO/Dignity Health CCC and Case Management program to providers. May also assist with appointments as directed.
Responsible for gathering clinical information from outside sources such as PCPs, specialists and other providers, hospital logs, Cerner, PCM, hospital case managers, and outpatient UM staff.Forwards information to staff for the purpose of evaluation for initiation of management as well as ongoing management by the DHMSO/Dignity Health CCC and Case Management program.
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Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law. For more information about your EEO rights as an applicant, please
If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this telephone number.
Job ID 2018-60684
Employment Type Full Time
Department Utilization Review
Hours / Pay Period 80
Facility Dignity Health Management Services Organization
Standard Hours Monday - Friday (8:00 AM - 5:00 PM)
Work Schedule 8 Hour