Coordinator - Integrated Transitional Care

Inland-Empire-Health-Plan-; Rancho Cucamonga (CA); Hybrid; USD 33,000 - 43,000; Full time

Benefits offered by this job

Competitive salary

Hybrid schedule

On-site fitness center

Medical, dental, and vision

Retirement options

Job summary

Inland Empire Health Plan (IEHP) is hiring a Coordinator - Integrated Transitional Care on a hybrid schedule in Rancho Cucamonga, CA. You will process authorizations, verify eligibility, and assist ITC nurses with non-clinical tasks while maintaining accurate medical records.

The role emphasizes timely processing, coordination across facilities, and strong data-entry skills in a fast-paced health plan environment.

Qualifications

• Two years of data entry experience, preferably in health care.
• Knowledge of ICD 10 and CPT codes is useful.
• Strong computer skills including word processing, databases, and spreadsheets.
• HMO or Managed Care exposure is a plus.

Responsibilities

• Process Authorization requests and verify eligibility promptly.
• Review and attach reviews and orders into the medical management system.
• Monitor intake from face sheets and ensure accurate demographic data.
• Coordinate with ITC nurses and providers to support care management.
• Attend meetings and promote a collaborative team environment.

Skills

Data entry

Customer service

Word processing

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Overview

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to anauthentic experience!

Under the general direction of the Manager and Supervisor in the Integrated Transitional Care department, the Coordinator - Integrated Transitional Care is a high paced position that requires timely processing of Authorization requests, verifying eligibility, obtaining additional information as requested by the Integrated Transitional Care Nurses. This position requires that one be organized with the ability to multitask with a working knowledge of ICD 10, CPT coding and Medical Terminology. The Coordinator - Integrated Transitional Care will work as an extension of the clinical team to complete all non-clinical functions as indicated.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more

• Competitive salary.
• Hybrid schedule.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Key Responsibilities

• Monitor the Right Fax server, EDI Interface, and medical management system intake to all face sheets are processed in a timely manner
• Ensure that hard copy and electronic face sheets are complete and accurate to reflect current Member demographic information
• Review of the daily census report in an effort to eliminate duplicates or other admission received from all contracted and non-contracted facilities not required by the health plan
• Cover Cisco ACD Queue telephone lines and phone queues
• Check eligibility and assigning Authorization to appropriate ITC nurse based on the Far tool
• Attach reviews and orders into the medical management system for review by the ITC nurse
• Review and approve service requests within the ITC Coordinator scope as indicated by the Utilization Management Guide approved by the Utilization Management Subcommittee
• Obtain Member discharge dates through daily calls, Electronic Medical Record or memo submissions to contracted and non-contracted facilities
• Meet the performance measurement standards for productivity and accuracy as well as timely processing of inpatient authorizations, inpatient service requests, and discharges
• Assist with the referral process by contacting provider by phone fax or email to request additional medical information as needed
• Set up hospital follow up appts for Member if needed and providing that information to the Member. Documenting the call within the medical management system
• Ensure Members receive Home Health and/or Durable Medical Equipment (DME) items as ordered via phone call and documentation of call within the medical management system
• Process and coordinate disenrollment, transportation as needed
• Represent the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department
• Communicate with providers/facilities in consultation with the ITC Nurse, regarding authorizations, orders, and clinical reviews
• Assist the ITC Nurse in the management and coordination of care of Member identified with care management conditions
• Collaborate on Member’s care issues with other team members and consults with ITC Nurse or ITC management to ensure that the appropriate treatment plan is followed, thoroughly and promptly
• Assist with identifying HEDIS Gaps and outreach to address with Member
• Ensure documentations is accurate and in compliance with regulatory requirements and accreditation standards
• Assist and provide support to Management or Inpatient Clinical Team as requested
• Attend Meetings as scheduled
• Promote a positive and collaborative working environment within the CM Team

Qualifications

Education & Requirements

• Minimum of two (2) years of experience as a data entry specialist
• Data entry specialist experience preferably in an HMO or Managed Care setting
• Utilization Management experience preferred
• High School Diploma or GED required

Key Qualifications

• Must have a valid California Driver's License
• Requires knowledge of ICD 10 and CPT codes
• Knowledge of utilization management in a health care delivery setting preferred
• Managed Care or physician office a must
• Skilled with computer applications, including word processing, database, and spreadsheets
• Good customer service skills

Work Model Location

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)

Word processing and data entry involving computer keyboard and screens, distribution of reports, filing and copying of records and/or correspondence. Position is eligible for telecommuting/remote work location model upon completing the necessary steps and receiving HR approval. The incumbent approved to telecommute may periodically be required to report to IEHP’s main campus for mandatory in‑person meetings or for other business needs determined by IEHP leadership

Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in‑person meetings or for other business needs as determined by IEHP leadership

Pay Range

USD $23.98 - USD $30.57 /Hr.