HCA, Hospital Corporation of America Clinical Reviewer in Irvine CA, California
Do you have a proven track record of establishing and maintaining a long-term customer relationship, building trust and respect by consistently meeting and exceeding expectations? Do you have demonstrated communication skills, able to work effectively with other employees, patients and external parties?
_We require you to have an LVN for consideration. _ _ _ Now is the time to join our team of motivated and nurturing individuals working to assist patients with their Treatment Authorization Requests (TAR) according to the Medi-Cal format. Ideal candidates will have a steady work knowledge of medical terminology, practices and procedures, as well as laws, regulations, and guidelines. You should also share a passion for our purpose, "To serve and enable those who care for and improve human life in their community."
Does this sound like you? If so, APPLY TODAY. See what makes us a fabulous place to work!
Parallon is now seeking a Full-Time Clinical Review Specialist
You can also Like us on Facebook: https://www.facebook.com/ParallonRCSJobs.
WHAT WE CAN OFFER YOU: * We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe deeply in our team and your ability to do excellent work with us. * Your benefits package allows you to select the options that best meet the needs of you and your family. Benefits include 401k, paid time off medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment.
SALARY * $20 - 29 per hour, depending on experience
WHAT YOU WILL DO: * Perform TAR reviews and completion of TAR requests according to Medi-Cal format and deadlines * Perform Medi-Cal clinical medical file review of hospital documentation for necessary clinical treatment and patient severity of illness to warrant admissions and continued acute inpatient level of care * Perform on line documentation of clinical justification for hospital stays and prescreening of files to determine if Appeal is warranted. * Document clinical justification for Appeal requests * Conduct clinical review of cases that do not meet criteria * Perform clinical intake and reviews cases according to the policies and procedures of Parallon. * Collect and enters confidential information ensuring the highest level of confidentiality in all areas. * Maintain written documentation according to Parallon’s documentation policy * Provide ongoing to TAR related to Parallon’s Clinical Review process * Assist in the orientation and training of new clinical TAR staff in department. * Participate and understands scope of responsibility in all ongoing of the TAR Process. * Have the ability to use independent judgment related to medical record review. * Adhere to and supports organizational IT&S standards, policies, and procedures, and adhere to Code of Conduct. * Perform other duties as assigned
ABOUT US Parallon believes that organizations that continuously learn and improve will thrive. That’s why after more than a decade we remain dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry’s leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services.
EXPERIENCE AND EDUCATION NEEDED: * High school diploma or GED required * Communication - communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately. * Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations * Interpersonal skills - able to work effectively with other employees, patients and external parties * PC skills - demonstrates proficiency in Microsoft Office applications and others as required * Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems * Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. #ParallonBCOM
Job: *Case Management
Title: Clinical Reviewer
Location: California-Irvine CA-Santa Ana (SAN) - RCPS
Requisition ID: 26588-155249