JOB OBJECTIVE

This position will work under the supervision of the Billing Manager.  The Billing Specialist will be responsible for the completion of all tasks to ensure accurate, compliant and timely billing of patient charges for appropriate reimbursement from all sources, such as patients and all other third party payers.   Billing Specialists will interact with a multi-cultural population of diverse socioeconomic backgrounds, ages, and level of education.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Billing Specialist is responsible for performing the following duties:

• Reviews charges, payments and adjustments to ensure accuracy and compliance with billing, coding and any contractual requirements  
• Generates paper or electronic claims and submits them to all third party payers such as Medi-cal Medicare, private insurances and other programs
• Generates patient statements and collection letters
• Enters payments received from payers and patients in the practice management system
• Reviews claim rejection queue and resolves for resubmission
• Follows up on denied and unpaid claims; works closely with payers  to provide any information necessary to receive payment
• Reviews and collects on overdue patient balances
• Answers questions from patients, staff and payers
• Reviews and processes requests for adjustments, corrections or refunds
• Prepares billing reports
• Collaborates and communicates with other team members to ensure efficiency of processes
• Maintains billing records
• Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

Description:

This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas del Camino Real, Inc. offers the chance to contribute to a growing marketing team. We offer a highly competitive salary; an excellent benefits package including full medical, dental, vision, life and disability insurance; and generous holiday, vacation and sick leave.

Duties:

Under the supervision of the Director of Marketing and Communications, the Communications Coordinator will be responsible for maintaining and improving the brand image and reputation of Clinicas del Camino Real, Incorporated across the Ventura County community. This includes leading brand efforts with regards to strategic marketing campaigns consistent with the mission and vision of the organization. Along with the rest of the marketing team, the Brand Coordinator will contribute to the department’s goals and objectives as well as report on ongoing initiatives.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Communications Coordinator will be expected to:

• Regularly report on brand initiatives and marketing performance.
• Organize company events to boost brand awareness both internally and in the community.
• Conduct market research as it pertains to company brand image and reputation management.
• Partner with talent and recruitment efforts to attract candidates for potential employment.
• Contribute to digital and traditional marketing content, tracking and measurement.
• Manage brand guidelines and organizational values as it pertains to brand marketing efforts.
• May supervise supporting staff.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Compliance and Risk Manager is responsible for performing the following duties:

• Manages day-to-day operation of the Compliance and Risk Program activities.
• Collaborate with internal departments and external agencies. 
• Develop, review and implement necessary programs, policies and procedures. Including promoting uniformity along all service lines (Urgent Care, Dental, Optical, etc.) 
• Educate and develop training material that promotes commitment to compliance with standards, risk management functions, policies and procedures. 
• Establish appropriate structures and processes in relation to risk reporting, incident management, safety, escalation of serious incidents and reporting (internally and to external agencies as applicable).
• Conduct confidential internal investigations for compliance complaints and or grievances, including those received via the Anonymous Helpline. 
• Assist in identification of potential risk through a risk assessment, analysis of accidents/incidents and near miss incidents, periodic safety inspections and/or audits.
• Support appropriate departments to ensure compliance with subpoenas and timely response to release of medical records to ensure full compliance with required HIPAA and other regulations. 
• Manage liability insurance accounts for the organization. 
• Keep up to date with health & safety legislation and guidelines and healthcare compliance regulations. 
• Work with legal counsel in situations of filed claims and protects the attorney-client privilege as appropriate.
• Collect and analyze data to identify vulnerabilities and make recommendations to reduce, prevent or eliminate risks identified.
• Perform other duties as assigned including participation in all safety programs which may include assignment to internal or external agency committees.
• Appoints, coordinates, and directs the work of the staff members in the Compliance Department.
• Collaborate on the FTCA Application for malpractice and annual risk report. 
• Prepare presentations and reports that address risk, capture trends and recommendations. 

Under the general supervision of the Compliance Manager, the Compliance Coordinator will manage and coordinate a variety of projects within Clinicas with a particular emphasis on Compliance. 

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Compliance Coordinator will be responsible for the following:

• Assist in developing, maintaining, and revising policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct which includes vulnerability to fraud, abuse and waste.
• Assist in coordinating and conducting mock audits, internal audits, developing audit reports, and coordinating the development of the corrective action plans.
• Assist in producing output (reports, spreadsheets, charts, graphs, dashboards, etc.) ready for customer audience with minimal review required.
• Coordinate the daily activities and priorities of the Compliance team. Assist in managing multiple deadlines.
• Assist in monitoring and coordinating compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
• Independently manage several regulatory calendars, including sending reminders and tracking completion to ensure ongoing compliance.
• Interact with regulatory agencies as needed.
• Log, schedule and coordinate all internal audit activities including preparing work papers and documentation to maintain an organized internal audit process.
• Assist in disseminating information throughout the company.  Maintain updated documents within the intranet site.
• Stays informed of all state/federal regulations and any changes that are instituted in the calendar year.
• Complete administrative and other duties as assigned including participation in all safety and compliance programs which may include assignment to an emergency response team.

Looking for Dental Assistant or Registered Dental Assistant

The Dental Assistant (DA) supports and provides chair-side assistance to Dentists. Assists with set-up of equipment, prepares patient for treatment and assists during procedures. The DA works under the supervision of the Dentist and Lead Registered Dental Assistant (RDA) and reports to the Health Center Manager. Interprets Dentist’s orders in terms understandable to patients of varied educational and cultural backgrounds. Works with a multi-cultural population of diverse socioeconomic backgrounds and ages.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Under the direct supervision of the Dentist or Lead RDA, the DA may perform the following duties:

• Sterilizes, prepares and arranges equipment and accessories.
• Keeps dental department and equipment neat, clean and sanitary.
• Utilizes common dental instruments, equipment and materials.
• Utilizes and understands dental terminology.
• Takes digital dental x-rays.
• Instructs patients in the proper practices of dental hygiene.
• Assists in the dental laboratory.
• Documents patient visits utilizing electronic dental records.
• Mixes amalgam.
• Takes impressions for diagnostic and opposing models.
• Removes sutures.
• Places and removes rubber dams.
• Places wedge and removes all matrices. Holds anterior matrices.
• Applies topical fluoride after scaling and polishing is provided by the supervising Dentist.  
• Applies non-aerosol and non-caustic topical agents.
• Removes post-extraction and periodontal dressings.
• Assists in the administration of gases; does not adjust the flow of the gases unless instructed to do so by Dentist who shall be present at the patient’s chair-side at the implementation of these instructions. This regulation shall not be construed to prevent any person from taking appropriate action in the event of a medical emergency.
• Assists with orthodontic procedures such as placing and removing elastic orthodontic separators, taking intra-oral measurements for orthodontic procedures, seating adjusted retainers or headgears, checking for loose bands, removing arch wires and ligature ties.
• Interacts in a professional manner and works collaboratively with Clinicas’ staff and patients.
• Provides excellent customer service to patients, vendors and employees.
• May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
• Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

The Director of Managed Care and Network Operations coordinates the activities and communications among managed care staff and the administration. The Director of Managed Care and Network Operations works collaboratively with Administration, Finance, Clinical Programs, Operations, Credentialing, Pharmacy, Data Analytics and others to research, develop, plan and implement innovative managed care strategies that maximize success in managed care. The Director of Managed Care will be responsible for negotiating managed care contracts and ensuring that requirements and initiatives are successfully executed within the healthcare delivery setting resulting in improved access to contracted services, improved outcomes, superior care and increased profitability.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Director of Managed Care and Network Operations is responsible for the following:

• Plan and direct the managed care program.
• Oversees the managed care plan operations, obligations & responsibilities inter-departmentally through the Clinicas System.
• Directs the department operations, activities, resources to meet budget and goals.
• Communicates and resolves issues.
• Initiate and lead the process of development, negotiation, implementation, monitoring and management of all managed care agreements.
• Conducts complex language and financial analysis with contracted providers and/or entities. Implements legal, financial & business requirements & objectives through negotiations.
• Develop, deploy and oversee contract strategy for hospitals, ancillaries, physicians and other professional services. Ensure services are in compliance with professional standards, local, state and federal regulatory requirements.
• Monitor health plans, providers, businesses and agencies to ensure that they efficiently and affectively provide needed services while staying with contractual agreements.
• Assist in developments of policies and procedures to adhere to the contractual agreements.
• Oversees the managed care plan, operations, obligations & responsibilities inter-departmentally throughout the Clinicas System. Directs department operations, activities, resources to meet budget and goals. Communicates and resolves issue.
• Develop and oversee the implementation of strategies to improve managed care performance in terms of utilization, patient access, cost, compliance with contractual quality measures, etc. Align improvement with quality and financial goals.
• Lead the identification, coordination and analysis of all financial, access and utilization data that results in clear business performance reporting and monitoring by payer and by lines of business. Works closely with Operations, Clinical Programs, Credentialing, Finance/Managed Care Analytics to do so.
• Review financial statements, contract and fee reports, and other performance data to measure trends and goal achievement, determine areas needing cost reduction and program improvement.
• Partner with leadership from Clinical Programs, Operations and Quality to develop and implement change strategies in the healthcare delivery setting.
• Plans and monitors activities and staff including hiring, orienting, training, mentoring, continuing education, and evaluating, coaching & disciplinary actions of supervised staff members.
• Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

JOB OBJECTIVE

Under the general supervision of the Health Education Outreach Coordinator and oversight from the Director of Health Education and Prevention Programs, the Health Education Outreach Specialist (HEOS) performs a variety of community services: health education community classes, health screenings and linking community to health care services.  The HEOS will primarily work in the community with specific target populations to promote Clinicas’ services in agricultural fields, packing houses, food pantries, and other community organizations, primarily focused on the farmworker and migrant target population throughout Ventura County. The HEOS interacts with a multi-cultural population of diverse socioeconomic backgrounds, ages and levels of education.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The HEOS is responsible for performing the following duties:

• Researches and verifies patient eligibility for different medical programs. 
• Registers and interviews patients to obtain accurate and complete demographic information.
• Informs patients about the availability of governmental funded and discount programs.
• Recruits new patients for CDCR and schedules appointments.
• Conducts community presentations and health screenings.
• Serves as an interpreter between provider and patient as needed.
• Conducts education at the appropriate level in a variety of areas including but not limited to preventative care, prenatal care, reproductive health, nutrition, chronic diseases, oral health and pediatrics.
• Utilizes a variety of resources to provide education including Department curricula, written educational materials, brochures, posters, models and videos.
• Conducts maternity tours at the contracted hospitals for prenatal patients as needed.
• Provides patient advocacy including assistance with community referrals, disability & paid family leave forms, WIC, medication assistance and other advocacy services aiding as a liaison to connect patients to resources.
• Promotes services via in-person, broadcast & social media as requested.
• Documents encounters using electronic health records, HED data base and other applicable forms.
• Will be required to both capture and provide information that is of a sexual health nature which will involve family planning. 
• May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
• Performs other duties as assigned including participation in all safety programs, which may include assignment to an emergency response team.
• Must have and maintain a valid driver license.

KNOWLEDGE AND ABILITIES

• Ability to work individually as well as in group settings with minimal supervision.
• Work with people of different cultural, ethnic, and social-economic backgrounds, particularly underserved populations and have a desire to help others improve their health.
• Must have dedication to team work and the ability to deliver exceptional patient service.
• Must have strong communication skills.
• Possesses excellent computer skills and have basic knowledge of computer programs (Word, Excel, Publisher, etc.).
• Interacts in a professional manner and works collaboratively with Clinicas’ staff and patients. Provides excellent customer service to patients, vendors and employees.
• Possess strong desire to improve the health and well-being of target populations. Be a self-motivated, independent, innovative thinker and a resourceful problem solver.
• Must have a flexible work schedule and be available to work weekends and evenings as requested.
• Complete and maintain program certifications as assigned by supervisor.
• Must have reliable transportation to be used during working hours for off-site appointments and outreach activities. 

The Lead Licensed Vocational Nurse (LVN) provides nursing services to ambulatory care patients and in emergency settings when necessary. Performs skilled tasks and paraprofessional nursing duties requiring specialized training. The Lead LVN reports to the Health Center Manager and works under the direct supervision Medical Provider when providing patient care. Interacts with a multi-cultural population of diverse socioeconomic backgrounds, ages and levels of education.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Lead Licensed Vocational Nurse performs the following duties:

• Provides nursing care to Health Center patients.
• Conducts patient screenings and assists provider with triaging
• Physically and psychologically prepares patients for treatments, examinations, and scheduled diagnostic studies.
• Sets up for minor procedures
• Instructs patients on proper use of medical equipment and teaches them skills to care for their particular medical needs.
• Is responsible for recognizing and interpreting symptoms and reporting condition of patient to the attending physician.
• Documents patient visits utilizing electronic health records system (EHR).
• Keeps inventory of stock medicines available and makes weekly drug and medical supply orders. 
• Administers treatment and medication under physician’s orders, except for intravenous medications.
• Verifies and administers immunizations upon physicians’ or standing orders.
• Prepares in-house monthly EHR reports.
• Provides supervision of Licensed Vocational Nurse and Medical Assistant personnel.
• Provides Licensed Vocational Nurses (LVN) and Medical Assistants with their assignments so as to ensure an effective and functional Health Center.
• Coordinates patient flow activities and assists with peer review of patient records in their quality of care system.
• Provides assistance in the development, planning and implementation of new and existing nursing policies and procedures.
• Ensures that policies are followed consistently and correctly by the LVN and Medical Assistant staff.
• Participates in the interview process and selection of LVN’s and Medical Assistants.
• Is responsible for facility orientation, training and supervision of immediate staff. 
• Participates in Quality Improvement as necessary.
• Adheres to and follows established nursing policies, procedures and practices.
• Is actively involved and communicates with the Health Center Manager and all respective staff to ensure sharing of information, problem solving and effective operation of the Health Center.
• Assists with and/or facilitates coaching and disciplinary process for staff. 
• Composes and delivers employee performance evaluations, skills checklists and performance plans when necessary.
• Presents at Staff Meetings and Quality Assurance Meetings.
• Presents information during daily team huddles.
• Conducts Clinical Orientation Trainings
• Coordinates MA/Nursing schedule
• Conducts monthly chart reviews.  
• Adheres to universal precautions.
• Adheres to and follows established nursing policies, procedures and practices.
• May float to other Clinicas sites when additional coverage is needed.
• May be required to approve employee timesheets and requests for time off.
• Interacts in a professional manner and works collaboratively with Clinicas’ staff and patients.
• Provides excellent customer service to patients, vendors and employees.
• May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
• Due to the nature of the job, may work with or be exposed to information or material of a sexual nature.
• Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

The Licensed Vocational Nurse (LVN) provides nursing services to ambulatory care patients and in emergency settings when necessary. Performs skilled tasks and paraprofessional nursing duties requiring specialized training. The LVN reports to the Health Center Manager and works under the direct supervision of the Lead Licensed Vocational Nurse and Medical Provider when providing patient care. Interacts with a multi-cultural population of diverse socioeconomic backgrounds, ages and levels of education.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Licensed Vocational Nurse performs the following duties:

-         Provides nursing care to Health Center patients.

-         Conducts patient screenings and assist provider with triaging.

-         Physically and psychologically prepares patients for treatments, examinations, and scheduled diagnostic studies.

-         Instructs patients on proper use of medical equipment and teaches them skills to care for their particular medical needs.

-         Is responsible for recognizing and interpreting symptoms and reporting condition of patient to the attending physician.

-         Documents patient visits utilizing electronic health records system.

-         Keeps inventory of stock medicines available and makes weekly drug and medical supply orders. 

-         Administers treatment and medication under physician’s orders, except for intravenous medications.

-         Verifies and administers immunizations upon physician’s orders.

-         Prepares in-house monthly EHR reports.

-         May provide supervision of Medical Assistant personnel.

-         Coordinates patient flow activities and assists with patient records audit for their quality of care system.

-         Participates in Quality Improvement as necessary.

-         Adheres to and follows established nursing policies, procedures and practices.

-         May float to other Clinicas sites when additional coverage is needed.

-         Interacts in a professional manner and works collaboratively with Clinicas’ staff and patients.

-         Provides excellent customer service to patients, vendors and employees.

-         May assist patients with mental illness, substance abuse problems and or/emotional disturbance.

-         Due to the nature of the job, may work with or be exposed to information or material of a sexual nature.

-         Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

The Medical Assistant I, II, III (MA) performs clinical and administrative duties in support of medical Providers. Interprets Providers’ orders in terms understandable to patients of varied educational and cultural backgrounds. Interacts with a multi-cultural population of diverse socioeconomic backgrounds and ages. Reports to the Health Center Manager and works under the direct supervision of medical professional staff, Lead Nurse, Lead LVN or Lead Medical Assistant

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Medical Assistant is responsible for performing the following duties:

• Interviews patients to obtain medical information and measures their vital signs.
• Escorts patients to exam rooms and prepares for the medical provider.
• Documents patients’ medical history, vital statistics and information such as test results in the electronic health records (EHR) system.
• Collects blood, tissue or other laboratory specimens as requested by medical provider and prepares them for testing.
• Prepares and administers medications as directed by medical provider.
• Translates and explains treatment procedures, medications, diets and medical provider’s instructions to patients.
• Performs blood draws, administers immunizations and injections.
• Prepares treatment rooms for patient examinations, keeping the rooms neat, clean and fully stocked.
• Cleans and sterilizes instruments and disposes of any contaminated supplies.
• Changes dressings on wounds.
• Contacts medical facilities or departments to schedule patients’ tests and/or admissions (on as-needed basis).
• Performs general office duties such as answering phones and completing forms when necessary.
• Takes inventory and orders medical, lab and office supplies and equipment.
• Maintains logs for recall purposes.
• Performs routine laboratory tests and performs daily testing controls.
• Operates electrocardiogram (EKG), and other equipment to administer routine diagnostic tests.
• Adheres to and follows universal precautions.
• Adheres to and follows established nursing policies, procedures and practices.
• Rotates to other Health Centers as needed.
• Interacts in a professional manner and works collaboratively with Clinicas’ staff and patients.
• Provides excellent customer service to patients, vendors and employees.
• May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
• Due to the nature of the job, may work with or be exposed to information or material of a sexual nature.
• Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

The Patient Services Representative (PSR) works under the supervision of the Health Center Manager. The PSR is the first point of contact for our patients and some of the duties include: • Greeting patients upon arrival and assisting them through the registration process. • Receives payments. • Completes patient’s intake forms and determines eligibility for patients’ ability to pay or their qualification in assistance programs. • Schedules and confirms appointments and works closely with the back-office to ensure an efficient and pleasant visit for our patients.

The Purchasing Coordinator/Agent is responsible for administering and managing an efficient and timely supply ordering program for the Corporation. The Purchasing Coordinator/Agent reports to the Controller/Finance Manager.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Under the Supervision of the Controller/Finance Manager the Purchasing Coordinator/Agent performs the following duties:

• Administers the Purchasing Program within established Policies and Procedures.
• Evaluates new potential vendors for integrity of product and record of past performance through verification of references, financial stability, technical abilities, and confirmation that they will adhere to established corporate policies and procedures.
• Provides recommendation to management for selection of vendors based on capabilities, performance, payment terms, quality of product or service and purchase price.
• Enforces review of requisitions for conformity and management approval before placement of order.
• Assesses current inventories prior to placing bulk orders.
• Establishes “certified” vendors.
• Researches affordable counterparts for requests when reasonable.
• Follows and enforces common practices or record keeping protocols in compliance with audit requirements.
• Provides assistance and information to management and vendors.
• Solicits three bids for costly items and services as per Policies.
• Maintains competitive bidding and documentation for on-going “certified” vendors.
• Communicates updates or issues to management in a timely fashion. Promptly answers questions and/or concerns with vendors and management as the need arises. Provides resolution to problems at hand.
• Handles vendor disputes as needed.
• Performs cost analysis, projected savings reports for Corporation. 
• Provides assistance to Purchasing staff as needed and assists the Finance Unit with projects as needed.
• Provides coordination and management of annual calibration of equipment and equipment inventory.
• Performs annual reviews of yearly contracts with certified vendors and seeks input from management team. 
• Participates in departmental meetings and special projects as needed. Communicates appropriately and demonstrates good interpersonal skills.
• Confidentiality with vendors and staff in maintained at all times. Privacy is important with vendor price list and contract with Corporation. 
• Adheres to established policies and procedures.
• Interacts in a professional manner and works collaboratively with Clinicas’ staff, management and peers.
• Performs contract review and assessment before approvals as part of cross-functional team to ensure all policies and procedures are followed.
• Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

JOB OBJECTIVE

Under the general supervision of the Operations Manager, the Referral Center Manager (RCM) directs, manages and analyzes all referral activities, including the referral appointment process, resolution of problems, tracking of referral metrics and staff supervision.  The RCM works closely with internal and external parties to achieve organizational goals, most importantly a closed loop process for patient referrals. Will interact with a multi-cultural population of diverse socioeconomic backgrounds, levels of education and ages.  

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Referral Center Manager is responsible for performing the following duties:

• Coordinates the work of and provides hands-on supervision of Referral Coordinators to manage referral appointment requests from all Clinicas’ health centers.
• Directs all departmental activities including scheduling, staffing and daily operations as well as administrative duties such as problem resolution and quality assurance monitoring.  Throughout the referral coordination process, monitors the status of referral requests and facilitates process to ensure patients secure referral appointments on a timely basis.
• Responsible for the hiring, training, on-going supervision and evaluation of all referral coordinator staff.  Coordinates and ensures the comprehensive orientation of new department employees and assesses baseline competency.  Works with the Human Resources Department in the recruitment of appropriate staff.
• Coordinates work schedules, coverage plans and assignments for referral coordinators.
• Ensures staff members follow departmental and organizational policies and procedures, including thorough knowledge of the referral appointment request process and compliance with Clinicas’ mission statement.
• Provides clear directions, consistent and timely feedback to referral coordinator staff.  Promotes teamwork in daily activities, exercises diplomacy and consistently uses effective communication skills, acting as a role model to employees.

Communicates with clinic staff, internal providers, patients, and external providers regarding scheduling issues. Follow-up and other necessary issues related to referral appointment management.  Throughout the referral coordination process, ensures that all involved parties are aware of the referral status

Clinicas Del Camino Real, Inc. has been providing quality primary and preventative health care services to the residents of Ventura County since 1971. We have an exciting opportunity for a Referral Coordinator, to work in our Referrals department in Camarillo, CA

The Referral Coordinator is essential in obtaining medically appropriate services inside and outside of Clinicas del Camino Real, Inc. Patient needs, including referral to a Specialist, are identified by the Clinicas practitioner and processes through an established referral system.  The Referral Coordinator expedites the administrative requirements for patient referrals, ensuring that appropriate referrals are made to participating providers within the patient’s health plan.

• Obtains appointments for Specialist visits and notifies patients of appointments.
• Acts as a resource regarding referrals and insurance plan guidelines. • Interprets medical guidelines, benefits, policies and procedures in support of their objective to expedite the referral process.
• Knowledgeable about the regulations of various payer sources including, but not limited to: Self Pay, Private Insurance, Medi-Cal, Medicare, Medi-Cal & Insurance Managed Care/HMO, Children’s Health and Disability Prevention (CHDP), Healthy Families, Family PACT, and California Children’s Services (CCS). Knowledgeable about the regulations regarding these various payer sources.
• Manages member/patient and provider inquiries regarding referral status, the authorization process and other issues in a courteous and professional manner.
• Data entry of authorization into Electronic Health Records and /or Utilization Review system, ensuring that all referrals are tracked through to a completed visit and a report is received.
• Collaborates with Providers, Health Center Nurses/Medical Assistants, and UM Nurses to obtain additional medical information and notifies UM Nurse of potentially urgent requests.
• Processes all referral requests according to Clinicas’ policies and procedures.
• Verifies member eligibility via insurance carrier and/or Medi-Cal web portal
• Participates in the introduction and implementation of new procedures.
• Makes recommendations regarding changes, improvements, or enhancements to appropriate staff.
• Assists with training and orienting new employees, as assigned.
• Coordinates and assists with obtaining surgery appointments and re-scheduling missed appointments as needed.
• Notifies patients of authorization status, as needed.
• Distributes denial letters to appropriate recipients.
• Attends meetings as assigned.
• Provides excellent customer service to patients, vendors and employees.
• May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
• Due to the nature of the job, may work with or be exposed to information or material of a sexual nature.
• Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

The Registered Dental Assistant (RDA) supports and provides assistance to Dentists chair-side. Assists with set-up of equipment, prepares patient for treatment and assists during procedures. The RDA works under the supervision of the Dentist and Lead Registered Dental Assistant and reports to the Health Center Manager. Interprets Dentist’s orders in terms understandable to patients of varied educational and cultural backgrounds. Works with a multi-cultural population of diverse socioeconomic backgrounds and ages.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Under the direct supervision of the Dentist or the Lead RDA, the RDA/RDAEF may perform the following duties:

• Sterilizes, prepares and arranges equipment and accessories.
• Keeps dental department and equipment neat, clean and sanitary.
• Utilizes common dental instruments, equipment and materials.
• Utilizes and understands dental terminology.
• Takes digital dental x-rays.
• Instructs patients in the proper practices of dental hygiene.
• Assists in the dental laboratory.
• Documents patient visits utilizing electronic dental records.
• Mixes amalgam.
• Takes impressions for diagnostic and opposing models.
• Removes sutures.
• Places and removes rubber dams.
• Places wedge and removes all matrices. Holds anterior matrices.
• Applies topical fluoride after scaling and polishing is provided by the supervising Dentist. 
• Applies sealant.
• Performs coronal polishing.
• Applies non-aerosol and non-caustic topical agents.
• Removes post-extraction and periodontal dressings.
• Assists in the administration of gases; does not adjust the flow of the gases unless instructed to do so by Dentist, who shall be present at the patient’s chair-side at the implementation of these instructions. This regulation shall not be construed to prevent any person from taking appropriate action in the event of a medical emergency.
• Assists with orthodontic procedures such as placing and removing elastic orthodontic separators, taking intra-oral measurements for orthodontic procedures, seating adjusted retainers or headgears, checking for loose bands, removing arch wires and ligature ties.
• Interacts in a professional manner and works collaboratively with Clinicas’ staff and patients.
• Provides excellent customer service to patients, vendors and employees.
• May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
• Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

Functions specific to RDA Extended Functions: (These duties are to be performed under direct supervision of a licensed Dentist. Procedures shall be checked and approved by the supervising dentist prior to dismissal of the patient.)

• Cord retraction of gingivae for impression procedures
• Takes impression for cast restorations, space maintainers, orthodontic appliances and occlusal guards.
• Prepares enamel by etching for bonding
• Formulates indirect patterns for endodontic post and core castings
• Fits trial endodontic filling points
• Applies pit and fissure sealants
• Removes excess cement from subgingival tooth surfaces with a hand instrument
• Applies etchant for bonding of restorative materials

The UM Nurse’s responsibilities include, but are not limited to:

      Level 1 - LVN:

• Conduct clinical review for service requests for medical appropriateness and medical necessity using clinical judgment, independent analysis, and knowledge of medical policies, clinical guidelines, and benefit plans
• Review, triage, and prioritize authorization requests to meet required turn-around times.
• Expedite access to appropriate care for members with urgent or immediate needs using the expedited review process.
• Research member issues and assess member needs related to authorization requests.
• Acquire appropriate clinical records, clinical guidelines, policies, EOC and benefit policy. Accurately applies coding guidelines.
• Develop determination recommendations and present cases to Medical Director (or designee) for potential denial determinations or when Medical Director input is needed.
• Interact with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements.
• Develop and/or review appropriate documentation and correspondence to member and providers reflecting determination. Ensure documentation is accurate, complete and conforms to established regulatory standards.
• Document all activities as per department practice including entry into automated systems. Recognizes potential quality of care concerns and refers as appropriate.
• Make appropriate referrals to California Children’s Services (CCS) and Tri-Counties Regional Center (TCRC).
• Identify and refer members who may benefit from care coordination programs, such as disease management or case management, and make appropriate referrals.                                             
• Attend meetings or meet with staff within the organization as assigned.
• Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

LEVEL 2 - RN: (in addition to above)

• Conduct clinical review for service requests for medical appropriateness and medical necessity using considerable clinical judgment, independent analysis, critical-thinking skills, and detailed knowledge of medical policies, clinical guidelines, and benefit plans.
• Utilizes strong critical thinking skills for complex clinical reviews and care coordination.
• Ensures that assigned health plans are meeting or exceeding Medicare/Medicaid/Commercial  performance benchmarks per health plan contracts.
• Builds and maintains relationships with internal and external clinical teams to help resolve barriers to referrals and care.
• Acts as a clinical resource to LVN staff. 
• Begins to influence department's strategy and provide constructive feedback to Medical Management leadership.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components, such as Medical Management system enhancements, and work is performed with minimal direction.

The Urgent Care Medical Assistant (Medical Assistant) performs clinical and administrative duties in support of medical clinicians in a fast paced Urgent Care environment providing care for urgent, but non-life threatening conditions. Interprets clinician’s orders in terms understandable to patients of varied educational and cultural backgrounds. Interacts with a multi-cultural population of diverse socioeconomic backgrounds and ages. Reports to the Health Center Manager and works under the direct supervision of medical professional staff and Lead Licensed Vocational Nurse.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Medical Assistant is responsible for performing the following duties:

• Escorts patients to exam rooms, measures their vital signs and prepares them for medical clinician.
• Documents patients’ medical history, vital signs and information such as test results in the electronic health records (EHR) system.
• Assists providers during examinations and procedures, including but not limited to splinting, sutures and skin lesion removals, among others.
• Collects blood, urine, tissue or other laboratory specimens as requested by medical clinician and prepares them for testing.
• Completes lab requisitions and prepares specimens for pick-up.
• Prepares and administers medications as directed by medical clinician.
• Translates and explains treatment procedures, medications, diets and medical clinician’s instructions to patients.
• Performs blood draws, administers immunizations and injections.
• Prepares treatment rooms for patient examinations, keeping the rooms neat, clean and fully stocked.
• Cleans and sterilizes instruments and disposes of any contaminated supplies.
• Changes dressings on wounds.
• Contacts other departments or external medical facilities to schedule patients’ tests and/or admissions (on as-needed basis).
• Performs general office duties such as answering phones and completing forms when necessary.
• Takes inventory and orders medical, lab and office supplies and equipment.
• Maintains logs for recall purposes.
• Performs routine laboratory tests and performs daily testing controls.
• Operates electrocardiogram (EKG), and other equipment to administer routine diagnostic tests.
• Adheres to and follows universal precautions.
• Successfully completes six-month and annual skills and competency checklist.
• Adheres to and follows established nursing policies, procedures and practices.
• Maintains a neat and professional image.
• Interacts in a professional manner and works collaboratively with Clinicas’ staff and patients.
• Maintains patient confidence and protects operations by keeping patient care information confidential in compliance with HIPAA regulations.
• Provides excellent customer service to patients, vendors and employees.
• May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
• Due to the nature of the job, may work with or be exposed to information or material of a sexual nature.
• Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

JOB OBJECTIVE

The vaccine coordinator will develop and implement routine and emergency vaccine management plan. The vaccine coordinator is responsible for all vaccine management activities, including training staff.  The vaccine coordinator reports to the Clinicas Nurse Manager and is responsible for the vaccine management across all of the Clinicas Health Center sites.  

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Vaccine Coordinator is responsible for performing the following duties:

• Ensures vaccines are delivered and designated employees at each site are trained to receive and store vaccines
• Ensure processes are in place to monitor expiration dates and inventory rotation so that the shorter expiration dates are used first. 
• Responsible for the set up and monitoring of vaccine temperatures ensuring vaccine monitoring devices are properly working.
• Ensure vaccine temperatures are being monitored at each site, and take immediate action when temperatures are outside acceptable ranges. 
• Implement the emergency vaccine management plan, if necessary. 
• Regularly review and analyze temperature data per policy.
• Ensure all vaccine policies are up-to-date and reflect current vaccine management evidence based best practices. 
• Perform a physical inventory of all vaccines in stock. Accounting for doses of returned, expired or transferred vaccines since last order.