Administrative Coordinator, Telephonic Inpatient Care

Job Summary

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.

• 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.