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Location

San Clemente, CA | United States

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Job description

About Crossover Health

Crossover Health is creating the future of health as it should be. A national, team-based medical group with a focus on wellbeing and prevention that extends beyond traditional sick care, the company delivers an entirely new model of healthcare—Primary Health—built on the foundation of trusted relationships, an interdisciplinary care team approach, and outcomes-based payment. Crossover’s Primary Health model integrates primary care, physical medicine, mental health, health coaching, care navigation and more, and delivers care in surround-sound—in-person, virtually and via asynchronous messaging. Together we are building a community of members that embraces healthcare as a proactive part of their lifestyle.

Job Summary

For patients who need care outside of Crossover’s Onsite and Near site clinics, we are actively curating a network of medical specialists in the community who will partner with us to coordinate and deliver excellent care. The focus is on demonstrated high-quality care, patient experience, practice efficiency, cost effectiveness, and a service level consistent with Crossover Health standards. This position will help to manage, update and curate this network in addition to taking over full logistical and workflow ownership of the referral process. This will include capturing all incoming clinic requests for referrals, managing the scheduling and appointment creation for all referrals, communications between patient, specialist, and Crossover, and documentation in the appropriate tools.

Job Responsibilities

• Daily processing of referrals to secondary care, outside of Crossover Health (specialists, imaging, community resources, employer benefits).

• Maintain high quality specialist, community service, and employer benefit directories.

• Maintain ongoing communication, tracking, and appropriate documentation on referrals to ensure continuity of care. This tracking may use an IT database.

• Ensure that referrals are addressed in a timely manner.

• Assist with training relevant stakeholders (MDs and CNs) on the external referral process.

• Assist with prior authorizations as needed.

• Be the single point of contact between specialists, the clinic physicians, and the patients when care is needed outside of a Crossover Health clinic, and provide updates as appropriate to the clinical team to ensure visibility into active referrals.

• Use clinical judgment and critical thinking to discern and refine the correct provider type and stratify the urgency of the referral, in consultation with clinical team members when necessary.

• Generate a complete referral packet and ensure timely submission to the specialist of the appropriate clinical documents to support the request for the referral (pertinent clinical notes, historical medical records, imaging reports, lab results).

• Ensure the arrival of the packet at the specialist office and a timely patient appointment.

• Work within the parameters of the patient insurance benefits and consult with benefit specialists as needed for the most high quality and cost effective care.

• Troubleshoot downstream complications or unexpected circumstances so that patient needs are placed first and gaps in care are averted.

• Interface regularly in a professional and collegial way with primary care MD’s and RN’s and clinic Hosts.

• Assist in the development of technology and service innovations to ensure a closed loop system of communication and coordination with our Crossover providers and network specialists.

• Performs other duties as assigned.

Required Qualifications

• At least 3 years of applicable experience (experience in a Primary Care setting preferred)

• High school diploma/GED required

• Proficient working with Google spreadsheets and/or excel, database management and data tracking

Preferred Qualifications

• Bachelor’s Degree or relative medical experience

• Experience processing referrals for a medical group

• Creative and flexible and effectively manages obstacles

• Excellent follow-through and have strong task execution skills

• Able to handle ambiguity when problem solving

• Thrive in a fast-paced and rapidly changing environment

• Ability to work in multiple technology platforms simultaneously, using clinical judgment and critical thinking in accessing and documenting information that pertains to each patient’s referral process

• Organization and accountability within a fluid and constantly changing environment

• Strong communication, customer service and people skills; the ability to connect with all stakeholders (patients, doctors, nursing staff, clinic staff, technicians)

• Excellent problem solving and problem preempting skills

• Willingness and drive to go the distance to help

• Work with a team to create new and improved workflows that build upon our new centralized referral management product

Physical Job Requirements

• May require standing, walking and sitting for extended amounts of time.

• Occasionally lift and carry items weighing up to 50 lbs.

• Manual and finger dexterity and hand-eye coordination

• Includes full range of body motion.

• Requires corrected vision, hearing and speech within normal ranges. Must be able to effectively communicate with patients and team members.

Crossover Health is committed to Equal Employment Opportunity regardless of race, color, national origin, gender, sexual orientation, age, religion, veteran status, disability, history of disability or perceived disability. If you need assistance or an accommodation due to a disability, you may email us at [email protected].

To all recruitment agencies : We do not accept unsolicited agency resumes and are not responsible for any fees related to unsolicited resumes.

#LI-Remote

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