Utilization Management Care Coordinator

Description

Company: Oak Street Health

Title: Referral Coordinator III

Location: Downers Grove; Remote (Work From Home)

Role Description:

The Referral Coordinator is a vital part of the Patient Experience & Service Operations (PXSO) and delivers an unmatched patient experience.  This role is responsible for managing the day-to-day referrals and diagnostic orders for Oak Street Health patients to see specialist providers.  This role interacts with center teams and payer partners to ensure patients are able to access needed care in a timely manner.

Core Responsibilities:

• Responsible for acting as a back-up for daily urgent and non-urgent referrals and diagnostic order when needed

• Complete any referral and diagnostics request, regardless of location or source, including CareReqs assigned to department

• Monitor and process pending urgent & non-urgent referrals and diagnostic orders

• Update patient information and make necessary updates/changes in electronic medical record

• Schedule appointments within electronic medical records platform 

• Schedule specialist appointments and/or diagnostic orders when needed

• Communicate referral and authorization information to patients

• Obtain required authorization for all third-party requests

• Request medical records, submit clinical document, and upload documents into electronic medical record platform

• Assemble information concerning patient's clinical background and referral needs

• Responsible for access to and information in multiple payer portals

• Navigate and produce results in multiple electronic platforms

• Verify non-preferred specialists and facilities for all referrals

• Contribute to the quality of the OSH Specialty Finder by appropriately submitting necessary changes 

• Interact professionally with internal and external partners and customers

• Support collaboration with OSH filed teams through the Alfred Line and through CareReqs

• Contribute to departmental workflows, protocols, and standards updates

• Acts as resource and expert-level knowledge of all payer portals

• Act as back-up admin for all payer portals

• Act as back-up admin for Specialist Finder updates and uploads

• Monitor and respond to CareReqs

• Support departmental internal and external training

• Support leadership in work allocation

• Respond to patient communications according to the responsiveness process

• Provide support and act as a resource to other Referral Coordinators

• Monitor and prevent backlog of referrals and diagnostic orders

• Provide feedback as to centers in need of additional support

• Maintain fax queues

• Responsible for leadership listserv maintenance

• Responsible for phone coverage for incoming calls from CCService and from centers

• Other duties as assigned. 

What are we looking for?

• Bachelor's degree preferred; High School diploma or equivalent required

• 2-3 years general administrative experience, referral, and authorization experience

• Demonstrated ability to complete daily work requirements with little to no supervision

• Able to provide coverage for all Oak Street Health markets

• Flexible and positive attitude

• Professional phone etiquette 

• Organized and able to manage competing priorities

• Strong computer skills and knowledge/familiarity with Microsoft Excel

• Strong communication and customer service skills

• Resourcefulness in problem solving

• Able to follow through on delegated tasks

• Health plan or provider order entry experience preferred

• Basic knowledge of medical terminology and/or medical coding preferred

• Proficient PC skills

• US work authorization

• Someone who embodies being 'Oaky'

What does being 'Oaky' look like?

• Radiating positive energy

• Assuming good intentions

• Creating an unmatched patient experience

• Driving clinical excellence

• Taking ownership and delivering results

• Being relentlessly determined

Why Oak Street Health?

Oak Street Health is on a mission to 'Rebuild healthcare as it should be'', providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient's communities, and focused on the quality of care over volume of services. We're an organization on the move! With over 150 locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody 'Oaky' values and passion for our mission.

Oak Street Health Benefits: 

• Mission-focused career impacting change and measurably improving health outcomes for medicare patients

• Paid vacation, sick time, and investment/retirement 401K match options

• Health insurance, vision, and dental benefits

• Opportunities for leadership development and continuing education stipends

• New centers and flexible work environments

• Opportunities for high levels of responsibility and rapid advancement

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply. 

Learn more at www.oakstreethealth.com/diversity-equity-and-inclusion-at-oak-street-health