Intake Coordinator - LPN - Hudson

As a Third Party Administrator (TPA) Health Design Plus (HDP) offers customized approaches to help organizations provide high-quality, cost-effective health care to employees. Our core business includes care management, network development and management, claims payment, customer service and benefit support services.
At HDP, we are committed to delivering innovative, member-centered solutions for our clients. We partner with employers to design and administer healthcare programs that achieve their goals. Our ability to implement creative new programs and new approaches to population health management has led to successful and sustained relationships with our TPA clients and interest in the wider market place for our non-core programs.
Our recent affiliation with University Hospitals of Cleveland, OH (UH) allows us to optimize our organizational strengths and enhance our offerings.
At HDP, we value capable and motivated individuals who strive for excellence. If you value a casual dress environment, enjoy a challenge and a fast-paced work setting, we invite you to apply today so you can be part of the HDP team.
The Intake Coordinator II functions as the gateway to the Care Management Department. The person in this position is responsible for collecting incoming information from varied sources and involves a combination of customer service capabilities, personal skills in communication, computers, problem solving ability and clinical knowledge. The person must utilize skills and experience to support comprehensive collection and coordination of medical services including making initial coverage determinations and authorizations based on established criteria, screening and referrals to other HDP programs (utilization, case, maternity and disease management). The person in this position will make decisions that are timely, appropriate, follow HDP guidelines while under the direction of a Registered Nurse.
Perform intake of service requests from providers or members received electronically, or via telephone or fax.
Triage and respond to incoming phone calls providing information and assistance to meet the caller's needs.
Access care management documentation systems for data entry and to support the existing programs and processes by collecting information, utilizing appropriate department policies, procedures and guidelines specific to members' eligibility, benefits and contracts.
Protects the confidentially of the member information and adheres to the Company policies regarding confidentiality
Support a team atmosphere.
Participate in department meetings and education in-services.
Identify and refer service requests to the appropriate clinical team member based on established processes.
Consult and accept guidance from appropriate clinical team members.
Document in a standardized format in the care management documentation systems in a timely, accurate and thorough manner.
Demonstrate knowledge of all programs and services available for members and proactively identify and refer cases to the appropriate program or service.
Maintain current professional licensure.
Identified/reports problems to the Manager
Position Requirements:
Strong clinical background with a minimum of 3 years experience in a medical office or other clinical setting
Knowledge of medical terminology and ICD9, ICD10, CPT, and DRG codes
Previous managed care or benefits experience desirable
Member advocacy skills and experience
Effective written and verbal communication skills required
Well organized and ability to multi-task essential
Must have fluency in software products used by the company
Telephonic customer service skills
Education Requirements:
Licensed Practical Nurse
License Requirements:
Licensed Practical Nurse
Preferred Qualifications:
Equal Opportunity Employer - Minorities/Females/Protected Veterans/Disabled

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