Referral Coordinator (188911-955)

Description



PRIMARY FUNCTIONS: Day to day operations of a single or multiple IPA and staff who are responsible for Medical Management processes, including but not limited to Utilization and Professional Case Management. Coordinates the Utilization process to ensure adherence to Management Company Policies and Procedures. Assist with development and revision of Policies and Procedures to ensure compliance with NCQA, CSMA, Health Plan Standards, state and federal regulations: Assist with implementation and continuity of utilization management functions,including authorization processes, referral processes and retrospective reviews. Serves as liaison with the local healthplan to ensure continuity for IPA members. Local delegation activity with focus on state and federal regulatory agencies. Required Experience



REQUIREMENT: Current license without restrictions to practice as a Licensed Practical Nurse by the State of Tennessee.

EXPERIENCE: Recent clinical experience in either a facility (acute care preferably), or physician office, or Health Plan. Must be computer literate and possess excellent verbal and written communication skills.