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Clinical Liaison, Client Support Center
MEDPOINT MANAGEMENT Los Angeles, CA
$78k-101k (estimate)
Full Time 6 Days Ago
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MEDPOINT MANAGEMENT is Hiring a Clinical Liaison, Client Support Center Near Los Angeles, CA

Job DescriptionReporting to the Supervisor, Client Support Center and VP, Quality Management, the Clinical Liaison is responsible for assisting client support TMs with IPA approval workflows that require escalation, expedited handling or additional clinical information to finalize authorizations.
Duties and Responsibilities
  • Assist Client Support Center leadership and staff to expedite approvals or updates of appropriate authorizations or the receipt of information from UM in order to determine authorization decisions
  • Notify Client Support Center staff authorization details contained in LOA utility if information is required to determine authorization decisions
  • Assist with training Client Support Center staff regarding relevant clinical conditions and treatments
  • Be available to explain UM workflow and assist with any barriers in the process
  • Participate in triaging authorizations as necessary to meet timeliness requirements
  • Assist with taking escalated calls from providers and offices when clinical experience is needed to address providers’ inquiries or concerns
  • Liaise with PNO as needed to determine provider access and availability for escalated clinical cases
  • Work with Client Support Center leadership to establish an efficient workflow to ensure that cases that meet criteria are moved to the Clinical Liaison priority status
  • Special projects and tasks as required
Minimum Job Requirements
  • Current LVN or RN licensure
  • Minimum five years experience working in MedPOINT’s inpatient or outpatient UM department
  • Expertise in Client IPA’s business rules, hospital capitation rules, and Outpatient UM Tools
  • Attention to detail
  • Capable of consistently meeting deadlines
Skill and Abilities
  • Effective verbal and written communication skills
  • Able to work well without supervision
  • Strong interpersonal skills
  • Excellent organizational skills and ability to multitask
  • Ability to work well in a busy department
  • Able to stay focused on the telephone despite noise and other distractions
  • Minimum or higher proficiency level with Microsoft Office Programs; primarily Word and Excel 2013 or higher
  • EZ-CAP® knowledge

Job Summary

JOB TYPE

Full Time

SALARY

$78k-101k (estimate)

POST DATE

06/24/2024

EXPIRATION DATE

08/23/2024

WEBSITE

medpointmanagement.com

HEADQUARTERS

WOODLAND HILLS, CA

SIZE

25 - 50

FOUNDED

1988

CEO

SHELDON LEWENFUFF PREIDENT

REVENUE

$10M - $50M

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About MEDPOINT MANAGEMENT

MedPoint Management provides IPA management, development and consulting services as well as comprehensive claims processing, medical affairs and financial operations. Clients receive the services of a large medical system in a smaller, more personal setting. MedPOINT Management, Inc. (MPM) provides all aspects of managed care management services to Independent Practice Associations (IPAs) and hospital clients. Our customized management approach meets the unique needs of each of our clients which allows us to successfully manage smaller groups comprised of single physician practices along with ...large groups of FQHC clinics and all practice models in between. Our experienced and knowledgeable staff provides a consistently high level of healthcare management services and strategies. Innovation and commitment to high quality, cost-effective care contribute to the overall satisfaction of our clients and members. Founded in 1987, MedPOINT currently represents a client base of over 4,000 contracted providers throughout California. Our managed IPAs are responsible for coordinating care for over 950,000 members in multiple contracted health plans. The contracts represent various payer mixes including Commercial HMO/PPO, Medi-Cal, Covered California (Exchange), Medicare Advantage and Medi-Medi including CalMedi Connect product lines. Understanding the power of information, MPM has made a significant investment in sophisticated IT systems enabling our management, clinical and administrative staff to efficiently work to coordinate high quality, cost effective, integrated care. The ability to readily track and trend utilization and quality metrics has been a vital component in improving overall health management, impacting the delivery of chronic and episodic care, yielding favorable health outcomes, and assisting our provider networks to meet or exceed health plan benchmarks for HEDIS, STARs and P4P programs. MedPOINTs full range of services are consistently delivered with the same high quality standards that has built our reputation. Flexibility, innovation and an openness to change are what the future demands of us as the nation moves into a new era of Health Care reform. The services MPM is delivering today will continue to embrace these notions to add value to our current and future client base. More
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