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Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
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Some awareness or knowledge of health/care reimbursement systems (Medicare Advantage, Commercial payer, Medicaid and CMS regulatory rules). The Patient Care Coordinator is responsible for overseeing the management and coordination of care for the acute inpatient population.
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Annually: Successful completion of PCC Assessment of Critical Skills, Passing score on inter-rater reliability. Send referrals/communicate with in-network vendors for coordination of post-acute levels of care such as Home Health, DME, IV infusion, SNF, Sub-Acute and Acute Rehab.
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SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.
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Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. Summary:Responsible for patient throughput and flow coordination in collaboration with the nursing bed coordinator and/or hospital supervisor, and entry of all admission, discharge and transfer (ADT) activity in Medipac at Presbyterian and Kaseman Hospitals.
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The PCC facilitates and coordinates with community providers and ambulatory case managers to assist with the appropriate level and transition of care for a safe discharge and preventing a re-admission.
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Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR.
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Community Memorial Hospital – Ventura has been awarded a prestigious five-star rating by the Centers for Medicare & Medicaid Services (CMS)! From our top tier insurance plans to our employee assistance program, take advantage of what CMH has to offer so you and your loved ones can have peace of mind now and for years to come.
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Review the Medicare, Managed Care, Medicare Advantage and Medicaid UB, CHAMPS, WebDenis. Process Medicaid applications. Review the Medicare, Managed Care, Medicare Advantage and Medicaid UB, CHAMPS, WebDenis.
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Travel: Yes, 10 % of the Time On-site: Work location is on-site (KP designated office, medical office building or hospital). The PCC collaborates with rounding MAPMG Hospital Based Service Physicians, patient/family, nursing, utlization review and other members of the healthcare team to assure continuum of patient care progression for clinical and cost-effective outcomes.
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General knowledge of government, regulatory billing and compliance regulations/policies for Medicare, Medicare Advantage, Commercial Insurance & Medicaid. General knowledge of government, regulatory billing and compliance regulations/policies for Medicare, Medicare Advantage, Commercial Insurance & Medicaid.
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The ideal candidate will have knowledge of payer sources such as long-term care insurance, Medicaid and Medicare Advantage as well as other federal, state/provincial, and local regulations.
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Collaborate with Social Worker to coordinate, long-term care, assisted living, financial assistance, and other services, as required. Assure follow up appointments and referrals to ambulatory case manager for high-risk patient population are scheduled and communicated to patient/family prior to discharge.
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