Case Mgmt Compliance Coordinator

Job ID
2021-149860
Employment Type
Full Time
Department
Utilization Review
Hours / Pay Period
80
Facility
Dignity Health Management Services Organization
Shift
Day
Standard Hours
8:00am-5:00pm
Work Schedule
8 Hour
Location
CA-Redlands

Overview

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.

Responsibilities

The Case Management Compliance Coordinator supports management in the daily administrative operations of the assigned area. Provides operational assistance of the Care Coordination and Utilization Management programs across all services areas. Will plan, direct and coordinate administrative functions associated within the assign area including ordering of supplies, equipment, and resources needed. Case Management Compliance Coordinator will leverage project management skills to prioritize and complete all assigned tasks, acting as a subject matter expert (SME) supporting assigned areas, and interacts with all levels of internal and external customers to answer questions and resolve issues as they arise. The incumbent will be expected to assist management with projects and other assignments as required.

Qualifications

This position performs complex compliance research and regulatory analysis which is applied to the monitoring of operational compliance within the organization. This position coordinates with the Compliance Business Analyst and all departments within the DHMSO Organization to develop, review, revise and implement policies and procedures driven by State and or Federal guidelines. This position may oversee multi-department compliance projects. This position may also participate in or oversee focused internal and external audits. 5 years of health care experience. Ability to resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relations. Ability to use Microsoft Office applications; Excel, Word, and Outlook. Ability to use the following general office equipment correctly and safely: desktop computer for data entry and typing, copy machine, scanner and facsimile machine, and of telephone equipment. Ability to be reliable in attendance and timeliness to work schedules. Ability to adhere to dress code, good grooming, and personal hygiene habits. Ability to maintain knowledge of and conform to company policies and procedures. Ability to maintain strict confidentiality at all times. Ability to maintain a high level of confidentiality at all times. Professional demeanor and appearance required Basic knowledge of various lines of health plan designs and benefits (i.e. PPO, HMO, Medicare, etc) Knowledge of ICD-9, ICD-10, CPT-4, and HCPCS coding. Must be attentive to detail, accurate, thorough, and persistent in following through to completion of all activities, demonstrating initiative for completing work assignments. Excellent communication skills; able to read, write, and speak articulately, using established channels of communication and reporting relationships within the organization. Ability to communicate effectively with all levels of internal/external staff. Willingness to work as part of a team, working collaboratively with others to achieve goals, solve problems, and meet established organizational objectives. Excellent communication skills required, including verbal and written

 

Minimum Qualifications:

 

  • 5 years of Healthcare experience
  • 1-2 years of health care leadership experience
  • Excellent communication skills required, including verbal and written
  • Professional demeanor and appearance required

 

Preferred:

  • Ability to resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relations.
  • Bachelors (BA/BS) in Healthcare Administration preferred.

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