Managed Care Liaison Supervisor, PIH Health - Home Health & Hospice, La Mirada, Full Time, Days
Location: La Mirada, California
Internal Number: 15779
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 multi-specialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services.
Oversees the daily activities of Managed Care Liaisons (MCLs) in the managed care operations of Home Health and Hospice. This position coordinates a team of RNs and LVNs who process referrals, authorizations, billing, quality assurance and utilization review and capitation for hospital services. Performs comprehensive review of the Outcome and Assessment Information Set (OASIS), Home Health Plan of Care and Strategic Healthcare Program (SHP) as required. Performs Utilization review as required on active and discharged patients. Supervisor reports to the Director of Finance. Collaborates with the Clinical team for Home Health and Hospice
California Registered Nurse License
Bachelor of Science in Nursing
Valid auto insurance
Previous experience in Home Health or Hospice
Experience with OASIS Assessments, all related documentation and regulatory standards for documentation.
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.
Experience in Quality Assurance and Utilization review.
Master of Science in Nursing
Certified Managed Care Nurse (CMCN)
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. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
PIH Health is the Communities’ Health and Wellness Partner
Our network of highly trained and compassionate physicians, nurses, clinicians, staff and volunteers work tirelessly and collaboratively every day to maintain and enhance the health and wellbeing of every member of our service areas. And when needed, we are here to coordinate care, manage chronic disease, and treat health conditions for the best possible outcomes.
We’re a nonprofit, regional healthcare network with three hospitals, numerous outpatient medical offices, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. Our leadership is dedicated to putting patients first—a cornerstone of our mission, vision and values—as we deliver top-quality healthcare.
We serve more than 3.7 million residents in the Los Angeles County, Orange County and San Gabriel Valley region.
Why PIH Health?
Our culture is built around our core values, which are the guiding principles for everything we do. For over 60 years, PIH Health has maintained a sense of community and a family-like cultur...e where patients are the top priority, and employees and volunteers are proud to be affiliated with such an outstanding organization.
PIH Health Hospital - Whittier
Our Whittier campus delivers outstanding and compassionate care to patients, every day. Among other awards, PIH Health Hospital - Whittier has been named one of the nation’s 100 Top Hospitals® for the third consecutive year by Truven Health Analytics. PIH Health Hospital in Whittier, CA is located 30 minutes east of Los Angeles, close to the Los Angeles and Orange County border. There are many great communities in which to live that surround the hospital. This means easy access to work, great dining, shopping, entertainment and spectacular beaches. Whatever your passion, you’ll find the right place for it here.
PIH Health Hospital - Downey is a nonprofit hospital with a rich, nearly 100-year history of meeting the healthcare needs of its community. The Downey campus is part of the PIH Health comprehensive health network consisting of two hospitals, 18 medical office locations and a host of specialty services. According to US News & World Report, the hospital scores highly in patient safety and orthopedics. With 955 employees, the hospital is the 5th largest employer in the city of Downey.