This is a part time position 20 hours per week.
Clinical Transplant Associate
Oakland, CA
Supports the Transplant Coordinator's case management efforts through clinical data collection, referral/authorization management, accessing appointments and consultations, facilitating the communication of medical information to the providers, managing data collection for administrative purposes, and coordinating travel arrangements and reimbursements for the members.
Essential Functions:
- Referral Management: Manages local regions referral review process for transplant authorizations; collects supporting documentation from available sources and presents case to reviewer per local region procedure
- Anticipates leakage out of the Network and develops processes to find and correct it according to local region policy and procedure and NTN exemption process
- Generates and ensures communication of authorizations to the referring provider, COE, member and claims unit
- Collaborates with the Transplant Coordinator, and local region Utilization Management to ensure that the process fulfills all regulatory requirements
- Collaborates with the claims department to ensure that claims are paid according to the appropriate contract and fee schedule
- Educates local providers regarding the referral process for Transplant Services; develops and implements systems to ensure that 98% of referrals for Transplant Services occur within Centers of Excellence
- Consistently supports compliance of responsibility (Kaiser Permanente code of conduct) by maintaining the privacy and confidentially of information, protecting the assets of the organization, acting with ethics and integrity, reporting non compliance, and adhering to applicable, federal, state, and local laws and regulations, accreditation, and licensure requirements (if applicable), and Kaiser Permanente policies and procedures
- Performs all other duties as assigned
- Clinical Information Management: Collects COE /Organ specific clinical information for the members with approved referrals for transplant; collaborate with the Transplant Coordinator to ensure that information is timely and complete
- Collaborates with the Transplant Coordinator to ensure accurate and complete Hub Intake Form
- Develops and implements systems for ensuring that clinical information from the COE or referring provider is received by the intended recipient in a timely and user friendly manner
- Develops processes and implements monitors for local region in-patient census to identify case managed members that have been admitted to an in-patient facility
- Collects clinical information for members approved for transplant; collaborates with transplant coordinator and physicians to ensure that information is timely and complete
- Performs order entry functions as directed by transplant coordinators and clinicians
- Collaborates with transplant coordinators to ensure that accurate information is forwarded to the COE and or retrieved from the COE
- Triages requests for clinical information from COE on behalf of transplant coordinators and clinicians
- Access to Clinical Services: Anticipates delay in processes and works to ensure members' timely access to required consultations/diagnostic procedures requested by COE
- Coordinates appointments for consultations/diagnostics with providers and members according to the medical indication
- Assume other duties as directed
Qualifications:
Basic Qualifications:
- Minimum three (3) to five (5) years experience in Utilization Management (required on original description)
- One (1) to two (2) years experience in an ambulatory clinical setting preferred (not stated?)
- Bachelor's degree, or equivalent experience, in health care administration, or related field (i.e., Clinical Transplant Care, etc)
- Strong problem solving and organizational skills
- Works well in multi-tasking team environment
- Competent in computer skills
An individual should have the following core behaviors:
Champions Innovation and Change
Collaborates
Communicates Effectively
Develops Self/Others
Drives for Results
Focuses on the Customer
Takes Accountability
Demonstrates Business Acumen
Exerts Influence
Emotional Intelligence*
Thinks & acts strategically
Solves problems planning & analysis
Leverages technology
Pays attention to detail
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.