IHA Physician
Job Details
Undisclosed
Corporate Headquarters - Chula Vista, CA
N/A
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Description

POSITION SUMMARY

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.

 

RESPONSIBILITIES

  • 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.

        EDUCATION
      • Current, unencumbered MD license in California.

        EXPERIENCE/SKILLS
      • One year, post graduate hands-on clinical experience.
      • Bilingual, English/Spanish preferred.

        PHYSICAL REQUIREMENTS
  • 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.
Qualifications

EDUCATION   

  • Current, unencumbered MD license in California.
     
    EXPERIENCE/SKILLS
  • One year, post graduate hands-on clinical experience.
  • Bilingual, English/Spanish preferred. 
     
    PHYSICAL REQUIREMENTS
  • 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 driver’s license, working/reliable vehicle, and automobile insurance.
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