Performs a comprehensive in-home assessments for members by reviewing all their needs including: medical, social/psychological, financial, caregiver support and environmental safety. Assist in resolution of member complaints and/or grievances.
COMPLIANCE WITH REGULATIONS
Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS and DMHC.
Conduct comprehensive IHAs that include, but are not limited to:
Review of member history.
Document treatment plan for each identified chronic medical condition to support the diagnoses. All documentation must be legible.
Document recommendations for additional screening tests as appropriate.
Assess need for home adaptation equipment.
Assess need for transportation to and from other health care providers.
Identify responsible party (decision maker) for Member or advocates, or any active family support/assistance. Document support contact information, if available.
Review and document Member medications, date(s) of prescription(s) and prescriber(s); note expired drugs.
Document all Member past and present medical conditions by ICD-10 code; collaborate with CHG claims coders.
Forward IHA record and superbill to CHG within three (3) Working Days of IHA.
Collaborate and regularly communicate with CHG Chief Operating Officer as requested.
Identify metrics and key performance indicators to be reported to CHG on a regular basis as mutually agreed upon by the parties.
Cooperate with CHG Chief Operating Officer to resolve Member complaints and grievances.
Notify CHG of broken appointments.
Meet with CHG, at CHGs request, to review cases and discuss opportunities for operational improvements.
Assist in resolution of member complaints and/or grievances.
When needed assist the HealthCare Services department in the completion of ICT's and other related duties.
Current, unencumbered MD license in California.
One year, post graduate hands-on clinical experience.
Bilingual, English/Spanish preferred.
Will be required to conduct home and on-site visits.
Constant driving within San Diego County.
Must be available to work evenings, weekends, and some holidays.
Will be required attend meetings outside of facility or normal business hours.
Valid drivers license, working/reliable vehicle, and automobile insurance.