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.