PRIMARY FUNCTION: Responsible for referring and authorizing patients to specialists and services not provided within the clinic. Collaborates daily with insurance companies and physician offices to obtain services for Malama I Ke Ola Health Center patients. 

POSITION REQUIREMENTS:

• Good organization, documentation and tracking skills.
• Computer literate and able to establish tracking and follow-up systems of referrals.
• Excellent interpersonal and communication skills. Able to relate to providers, patients, insurance companies and other medical providers effectively.
• Basic skills in working with diverse and marginalized populations.
• Attunement to ethical and legal standards of care.

ESSENTIAL DUTIES AND FUNCTIONS

• Arranges patient’s consultation with specialists.
• Contacts specialists and arranges appointment.
• Arranges secondary or subsequent referrals made by initial specialist.
• Obtains authorization for in-hospital consultations made by CCM providers.
• Obtains authorization for patients with same day appointments with another provider.
• Obtains from insurance companies, reauthorization of expired referrals for missed appointments or follow-up visits.
• Coordinates with insurance companies, air/ground transportation for patients needing referral to Neighbor Island.
• Follow up and attempt to obtain authorization for payment on denied claims for services performed by CCM.
• Obtains authorization for patients who have moved to Neighbor Island and are establishing care with a new PCP.
• Obtains authorization for patients referred to CCM by another provider.
• Obtains authorization for surgeries and procedures.
• Obtains approval for patients who are changing PCP to CCM.
• Tracks referrals and ensure timely submission of consultation reports.
• Coordinates referrals with nursing staff.
• Trains nursing staff on referral coordination.
• Makes every reasonable effort to provide referrals as quickly as possible and minimizes patient wait time to receive referrals and authorizations.

• Ethics and Law
  • Demonstrates a strong commitment to adhering to ethics, with special attention to dual relationships, confidentiality, informed consent, limits of competence, and team functioning.
  • Follows state laws, especially with regard to abuse reporting, adolescent reproductive health, and determination of decision-making capacity.
  • Timely documentation submission as soon as possible and within 24 hours from the patient encounter.

• Team and Interpersonal Skills
  • Demonstrates strong conflict resolution skills.
  • Understands and follows the organizational structure and reporting lines when addressing problems.
  • Possesses mindfulness skills, strong self awareness, and emotional management in a team environment.
  • Able to establish, maintain, and promote strong and cooperative working relationships with all staff.
  • Attends and participates in meetings and quality improvement activities as required.
  • Serves as a member of committees as requested.
  • Monitors CCM’s behavioral health program, identifying problems related to patient services and making recommendations for improvement.
  • Furthers the mission of the organization through active support of the strategic goals and CCM values.

• Safety and Compliance
  • Attend all required in-service and external training related to Safety and Compliance.
  • Read, watch safety & health videos, and adhere to all policies and procedures in Safety and Health Guidebook.

• QUALIFICATIONS

  Education: High school graduate or equivalent. Training/education in clinical field.

  Experience/Skills: 

  • Healthcare background with knowledge of clinical procedures, terminology and healthcare resources.
  • Good organization, documentation and tracking skills.
  • Computer literate and able to establish tracking and follow-up systems of referrals.
  • Excellent interpersonal and communication skills. Able to relate to providers, patients, insurance companies and other medical providers effectively.
  • Basic skills in working with diverse and marginalized populations.
  • Attunement to ethical and legal standards of care.
  • Valid driver license, reliable transportation, and proof of current vehicle liability insurance is required.