RN, MANAGED CARE LIAISON, PIH HEALTH - HOME HEALTH, La Mirada, Full time, daysApply Now Job ID 11874-977 Date posted 05/11/2021
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM.
The registered nurse (RN) Managed Care Liaison (MCL) possesses those abilities that combine clinical expertise in community health with an understanding of financial aspects of home care and aptitude for collaboration with third party payers regarding patient care. RN MCL serves as liaison between the patient, payers, and other applicable care team members, to review, authorize and provide oversight of home health services for patients with a variety of managed care health plans.
- Understanding of the cost of providing home health service/hospice and the scope of the department's services.
- Familiarity with prevailing prices/practices of the area.
- Strong verbal skills.
- Basic computer knowledge and abilities and calculator abilities.
- Ability to organize and prioritize.
- Broad knowledge of Medicare and Medi-Cal coverage.
- Understanding of clinical range of home care.
- Ability to negotiate. Understands and is focused on good customer service.
- Current California license as an RN. Renewal every 2 years in good standing.
- Minimum of one year experience in community health nursing, current acute care knowledge, and skills.
- Knowledge of Title 22 and Medicare Coverage Manual.
- Able to demonstrate broad knowledge of third-party insurance, Managed Care, Medicare, Medi-Cal, Medicare Advantage, HMO, and PPO regulations governing home health and hospice.
- Current CPR card.
- Current California driver's license and valid auto insurance.