Patient Services Coordinator (Finance)

Riverside University Health System Community Health Center - Main Campus is seeking a Patient Services Coordinator to provide vital support in managing patient referrals and ensuring smooth coordination of specialty care visits. This position will involve following up on referrals, re-directing them as necessary, and working within work queues to ensure patients attend their scheduled specialty visits. The coordinator will also maintain regular contact with patients to provide updates, gather necessary information, and address any concerns.

Work Schedule: 5/40 Monday - Friday 8am - 4:30pm
Location Schedule: Main Campus - Pediatric Clinic , Moreno Valley but travel is needed for Patient care throughout riverside county and offsite training

Work Duties:
• The Patient Services Care Coordinator provides care coordination and connection to services and social supports for ECM Members, including appointment scheduling and referral management.

• Provides ongoing monitoring of the Targeted Engagement List (TEL).

• Ideally working with a caseload of Members identified as being low risk (Tier 3).

• Supports RN Care Manager, BH Care Manager, and Community Health Worker with delegated tasks.

• Assists in the coordination of appointments and referrals for physical and behavioral health appointments.

• Collaborates on Member care issues with other ECM Care Team members, participating in weekly systematic case reviews and ad hoc case reviews, and consults with Registered Nurse Care Manager and/or the Behavioral Health Care Manager before taking any action that is clinical in nature.

• Connects ECM Member to other social services and supports he/she may need.

• Uses relationship-based strategies to engage Members in care as well as motivational Interviewing.

• Assists with arrangements such as transportation, directions, and completion of durable medical equipment requests.

• Responsible for at least one meaningful outreach per enrollee per month.

• Responsible for ongoing engagement with Members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the Member and his or her medical/behavioral team, as well as to increase the Member's sense of control over their whole health.

• Other duties as assigned, based on organizational needs and the evolving nature of the role.

Desired Experience:
Bilingual in Spanish preferred Complex case management experiences with pediatric patients age 0-21 has following conditions:
Complex Medical Condition
Homelessness
Serious Mental Health (SMI) and/or Substance Use Disorder (SUD)
High ED or Hospital Utilization
Children involved in Child Welfare
Birth Equity and Justice Involved• Assist physicians and other healthcare providers by providing care coordination to ensure patients receive optimal care; interact with Primary Care Providers, Specialty Providers, and other healthcare staff to coordinate care for patients.

• Liaison between healthcare staff and patients regarding maintenance of care and treatment; work closely with Providers to ensure continuity of care and treatment; facilitate communication among patients, physicians, nurses, and other healthcare staff regarding their care, including making appointments, treatment authorizations and resource needs.

• May assist with patient referrals to appropriate community resources; may provide patient education.

• Daily management of referrals which includes, input of data into manage care system, verify member eligibility, provider participation, and tracking of pending referrals.

• Authorize Treatment Authorization Requests (TAR) for the County of Riverside Medically Indigent Services Program (MISP); coordinate Durable Medical Equipment (DME) for all Managed Care Health Plans, public and private, coordinating quotes and equipment availability.

• Assist with transfer of patients to and from RUHS Medical Center and Care Clinics and other outlying hospitals for specialized care; verify patient eligibility with associated health plans.

• Coordinate with contracted IPA's and return copies of all appropriate clinic, surgery, and emergency room progress notes; process and authorize all requests for pharmacy that are not covered in the Drug Formulary.

• Request and review all emergency room notes for managed care patients that are seen through the Emergency Department; ensure return of all notes (i.e., outpatient, surgical, and emergency) to appropriate PCP or IPA.

• Coordinate patient transfers to other facilities for higher-level of care; coordinate with Medical Social Workers to facilitate care for patients; assist patients in qualifying for Medi-Cal or other programs.

• Process Third Party claims by determining and supplying information to and from attorney respective of patient's eligibility at the time of an accident.Education: Graduation from high school or possession of a Certificate of Proficiency issued by the California State Board of Education, or attainment of a satisfactory score on a G.E.D. test.

Experience: Three years of increasingly responsible, broad and varied clerical experience, at least one year of which included working in a managed care, healthcare, or behavioral health setting. For the RUHS care management program, experience as a Licensed Vocational Nurse or experience equivalent to the County of Riverside Behavioral Health Specialist I class is preferred.

Knowledge of: Rules and regulations pertaining to the confidentiality of medical information from federal, state and county agencies; medical terminology and basic laws of healthcare facilities and hospitals; federal, state and county regulations related to healthcare compliance.

Ability to: Interpret medical information, diagnosis and apply medical guidelines; communicate effectively orally and in writing; maintain effective working relationships with a wide variety of individuals; work independently, as well as in a team environment; operate a variety of telephone technology systems; understand the capabilities and applications of information processing equipment, considering the requirements of the program; utilize motivational interviewing skills; work efficiently in a fast paced environment; provide excellent customer service.BASED ON THE NUMBER OF APPLICATIONS RECEIVED, THIS POSTING MAY CLOSE WITHOUT NOTICE.

For specific questions regarding this position, contact Jesus Colin at JColin@rivco.org .