Kaiser Permanente Clinical Transplant Associate in Los Angeles, California

Supports the Transplant Coordinator's case management efforts through clinical data collection, referral/authorization management, accessing appointments & consultations, facilitating the communication of medical information to the providers, managing data collection for administrative purposes, & coordinating travel arrangements & reimbursements for the members.

Essential Functions:

  • Referral Management: Manages local regions referral review process for transplant authorizations; collects supporting documentation from available sources & presents case to reviewer per local region procedure. Anticipates leakage out of the Network & develops processes to find & correct it according to local region policy & procedure & NTN exemption process.

  • Generates & ensures communication of authorizations to the referring provider, COE, member & claims unit. Collaborates w/ the Transplant Coordinator, & local region Utilization Management to ensure that the process fulfills all regulatory requirements. Collaborates w/ the claims department to ensure that claims are paid according to the appropriate contract & fee schedule.

  • Educates local providers regarding the referral process for Transplant Services; develops & implements systems to ensure that 98% of referrals for Transplant Services occur w/in Centers of Excellence.

  • Consistently supports compliance of responsibility (Kaiser Permanente code of conduct) by maintaining the privacy & confidentially of information, protecting the assets of the organization, acting w/ ethics & integrity, reporting non compliance, & adhering to applicable, federal, state, & local laws & regulations, accreditation, & licensure requirements (if applicable), & Kaiser Permanente policies & procedures. Performs all other duties as assigned.

  • Clinical Information Management: Collects COE /Organ specific clinical information for the members w/ approved referrals for transplant; collaborate w/ the Transplant Coordinator to ensure that information is timely & complete.

  • Collaborates w/ the Transplant Coordinator to ensure accurate & complete Hub Intake Form. Develops & implements systems for ensuring that clinical information from the COE or referring provider is received by the intended recipient in a timely & user friendly manner.

  • Develops processes & implements monitors for local region in-patient census to identify case managed members that have been admitted to an in-patient facility. Collects clinical information for members approved for transplant; collaborates w/ transplant coordinator & physicians to ensure that information is timely & complete. Performs order entry functions as directed by transplant coordinators & clinicians.

  • Collaborates w/ transplant coordinators to ensure that accurate information is forwarded to the COE & or retrieved from the COE. Triages requests for clinical information from COE on behalf of transplant coordinators & clinicians.

  • Access to Clinical Services: Anticipates delay in processes & works to ensure members' timely access to required consultations/diagnostic procedures requested by COE. Coordinates appointments for consultations/diagnostics w/ providers & members according to the medical indication.

  • Reduces redundancy & outside costs by collaborating w/ the transplant coordinator to maximize repatriation of services whenever it is clinical appropriate & w/in the confines of the members contract w/ the Health Plan.

  • Ensures that authorization for outside services are accurate & communicated to all effected parties.

  • This job description is not all encompassing.

Basic Qualifications:

Experience

  • Minimum three (3) years of experience in utilization management (required on original description).

Education

  • Bachelor's degree, OR four (4) years of experience in health care administration, or related field (i.e. Clincial Transplant Care etc.).

  • High School Diploma or General Education Development (GED) required.

License, Certification, Registration

  • N/A

Additional Requirements:

  • Strong problem solving and organizational skills.

  • Works well in multi-tasking team environment.

  • Competent in computer skills.

  • Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

  • Minimum one (1) year of experience in an ambulatory clinical setting preferred.

COMPANY: KAISER

TITLE: Clinical Transplant Associate

LOCATION: Los Angeles, California

REQNUMBER: 681656

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.