Overview Be among the first 25 applicants. We’re delighted you’re considering joining us! At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
Join Our Team! Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.
DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it\'s right!
Salary: Salary: $30 - $33 hourly
Hill Physicians is an Equal Opportunity Employer
Job Responsibilities
Proactively assist the Care Transition Manager with providing information to the patient regarding the transition of care. Develop relationships to facilitate discharge planning and continuum of care needs. Perform duties to avoid readmissions and ER visits to the hospital. Analyze and trend data to improve overall utilization metrics.
Educating the patient about what to expect, review criteria to determine benefit structure, authorize and approve benefits as medically necessary.
Engage the patient and caregivers upon admission to the hospital and throughout the hospital stay, discharge instructions, transition preparedness, follow-up appointments, and care, using teach-back methodology to assure the patient understands the treatment plan and is well prepared for transition to the next level of care; in coordination with the Care Transition Manager.
Assist the unit nurse and Care Transition Manager with medication reconciliation at admission and near the time of discharge, ensuring medications are those likely to be continued as outpatient considering formulary and affordability.
Notify the Primary Care Physician (PCP) of the patient’s admission to the hospital and facilitate collaboration between hospital treating physician and PCP. Collaborate with the interdisciplinary team to ensure the plan of care is understood and documented. Participate in rounds with physicians, case managers, and social workers as needed. Ensure discharge documents are delivered to the PCP and to care management at Hill Physicians. Work with the onsite Case Manager and Hill Concurrent Review nurse to authorize and plan post-discharge services as far in advance as possible.
Ensure timely tests, consultations, imaging studies, treatments and procedures; identify and address barriers to avoid delays. Contact doctors or care team members as needed to move care forward.
Arrange PCP follow-up appointment as soon as possible after admission for a visit not more than 10 days after discharge; ensure appointment time is known by the patient, unit nurse, and documented on the discharge document, including arrangements for home health, home infusion, durable medical equipment, skilled nursing and rehabilitation. Collaborate with the interdisciplinary team to implement the discharge plan.
Refer patients to Hill Physician Case Management for the post-discharge “Welcome Home” program.
In Collaboration with CTM and Team
Provide resource information and referrals.
Interpret and coordinate health plan benefit coverage with member’s healthcare needs.
Refer patients to Health Education and Health Plan Disease Management programs as appropriate.
Coordinate all services and interventions with participating providers and the member through effective and timely communications.
Negotiate for out-of-benefit/network services and for cost-effective healthcare utilization.
Performance and Quality
Measure outcomes to determine if quality and cost-effectiveness of case management are met.
Examples of outcomes data include member surveys, quality of life, clinical and financial data.
Participate in Quality Improvement activities by analyzing quality data and identifying opportunities for improvement.
Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.
Coordinate internal and external resources for the individual member.
Utilize existing reports and systems to identify utilization patterns and facilitate needed care coordination to support Quality Improvement.
Refer to Hill Concurrent Review Supervisor for supportive interventions as needed (e.g., Health Education, Quality Management).
Ensure patients whose surgeon desires co-management are seen by the appropriate consultant or hospitalist.
Arrange visits by a home-visiting physician when beneficial to the patient; extend visits to skilled nursing or rehabilitation facilities if requested.
Attend ACO, Hospital, and Health Plan meetings as needed.
Required to drive or travel daily for work-related duties.
Other duties as assigned.
Qualifications
Required Experience: 3-5 years of related managed care experience required.
Ability to coordinate effectively with a variety of customers including members, providers, hospital and office staff, health plans, internal departments, community resources, and peers.
Ability to work effectively with physicians, hospital and office staff, and members.
Ability to work independently as well as in a team environment.
Multi-tasking and prioritization with strong critical thinking skills.
Excellent organizational and communication skills and ability to meet timeframes.
Computer literacy: Microsoft Word and Excel; able to use Excel for routine applications and Internet resources.
Strong ability to analyze and trend utilization management data and develop a process improvement plan.
Experience with CPT/ICD-9 codes preferred.
Education
Required Education: High School Diploma/GED required.
Medical Assistant Certificate preferred.
Additional Information
Note: Refer to salary above; location: Sacramento, CA.