Provider Contracting Director jobs in Pomona, CA

Position Summary:

The Director of Administrative Operations is responsible for management and oversight of inpatient, including related case management and discharge planning. The position is directly responsible for managing the daily administrative operations of the Medical Management Department. Responsibilities include development and implementation of procedures, training, and processes to assure compliance with RMG policies and procedures. The Director works collaboratively with the VP on daily management of Medical Management staff, auditing functions, and assuring that all staff provides a level of customer service that meets or exceeds the organization's expectations. The Director is knowledgeable of all contractual arrangements with providers, hospitals, and health plans.

The Director of Administrative Operations is responsible, along with other members of

Utilization/Care Management Teams for contributing to the quality, financial and patient satisfaction outcomes of Regal Medical Group.

Essential Duties and Responsibilities include the following:

Daily Inpatient Coordinator Audits

o Identifies secondary/alternate coverage (Medicare, PPO, etc) when creating cases

o Checks for TOC/TPL when applicable

o Navigate through P: Drive for higher level of care codes

o Familiar with identifying if a hospital is Per Diem vs. DRG

• Ensure case accuracy for census (including AH, TT & Medi-Cal team cases)
• 24 hour response time on all Emails from various depts
• myAdp
• Performance Evaluations
• PTO
• Schedules
• Interviews
• Ongoing Training
• Coaching/Development
• Team Building
• Privileges
• Quarterly Coordinator Meetings
• Lead/Supervisor Monthly Meetings
• Development of inpatient coordinator ladder structure
• Run admission data/report for staffing needs and load leveling
• Schedule training for staff in conjunction with supervisor
• Ability to run census for rounds
• Ability to calculate campus budget by LOB
• Ability to handle escalated calls
• Work collaboratively with other departments in organization

o Train and Transition all coordinator staff to home departments.

o Reach out to PCP/Specialist management staff when access issues develop.

o Review/audit Transfer team cases/completion

o Review/audit AH team cases/completion

o Hospice team –to confirm enrollment/revocation

o Network Management –Obtain LOA/agreements for Vendors/Providers as requested as part of DC planning

o Post discharge outpatient management

• Disease Management
• Renal Team

HospitalistDuties:

• Schedules- all regions for Hospitalist and SNFist. Coordinating with all physicians either via tiger text or email(s).
• Fax folders – clearing it out , taking care of all prescriptions request, paper work for our hospitalist daily
• Participate with health plan reporting and Audits
• Maintain Calendar - contracted providers
• Meetings- agenda & catering
• Lab coats
• PTO requests
• Phone Calls/Texts/Emails
• Billing
• Expense Checks
• Check Requests
• Contracted Provider Invoice
• Employed Time Sheets
• Medical Records/Signature Due
• Develop Hospital Discharge Program

Hire and train discharge schedulers to work directly with the Inpatient team to ensure a safe transition out of the hospital. The discharge Appt scheduler will reiterate the physicians care plan in regards to appointments and emphasize the importance of attending follow up visits/compliance with the care plan

o The goal is to have discharge Appointment schedulers for all LOB's to meet health plan requirements.

o Metric is to lower readmission rates

• Post-Discharge Schedulers

o Hire and train post discharge schedulers to arrange all PCP and specialist appointments for all discharges to alleviate inpatient coordinators from this task. In doing so, they will be able to incur additional responsibilities such as post discharge management

• 30 Day Post-Discharge Management

o Enhance scope and roll out to all South campuses

o Provide a primary contact person from RMG/LMG

o Ensure member is aware of PCP and urgent care locations in order to utilize the UC rather than the ER

o Avoid readmissions by providing frequent follow up calls and ongoing care as needed

• AH Discharge Confirmation (DPL)

o Confirm all discharges by campus utilizing all resources after hours

o Confer with inpatient medical director on any potential delays or obstacles and request clinical input as needed to facilitate safe discharges

• Transfer Follow-up

o Ensure transfer to appropriate facility is completed

o Ensure SNF placement is secured

• ER diversions to have follow-up within 24 hours
• All other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $150,000 - $180,000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and / or Experience:

• Bachelor's degree and/or 5 years of medical management experience.
• 5 years of medical group/IPA experience.
• Medical terminology, ICD9 and HCPC coding, LEAD (Access Express), EZ-Cap, IDX. Good phone etiquette required.
• Proficient in Microsoft Office and Outlook (Excel, Word).