RCMG is a Medi-Cal focused Independent Physician Association (IPA). Our commitment is to partner with Physicians, Health Plans, Community Health Centers and other health care facilities to coordinate member access to the quality medical care services that RCMG members receive.
Some examples of the administrative functions we offer to our providers are:
- Streamlined claims administration
- Utilization management
- Quality management
- Peer review
- Timely credentialing
- HEDIS coordination
- Wellness programs
- Health education material
River City Medical Group is committed to establishing trusted relationships with our provider partners through transparent operations. We are supported by four of the largest health plans in Northern California: Centene/Health Net, Anthem Blue Cross, Aetna, and Molina. This commitment results in a dynamic organization that implements innovative programs for improved member outcomes, a more streamlined and efficient process, and a healthier more engaged member population.
Provider Onboarding Program (POP)
Unique 2-tier program to review, facilitate and train providers on more accurate and timely claims submissions.
Clinical Operations Support
The RCMG Clinical Operations team has deep experience in medical office operations. We serve as a resource to our provider partners, helping them to improve efficiency and enabling them to spend more time in direct patient contact. We leverage our expertise in Medi-Cal with experience in EMRs, clinical operations and workflows to help providers build long-term internal capabilities.
To bring a more comprehensive perspective to HEDIS data management, RCMG has created an in-house HEDIS team to manage HEDIS data collection at the provider level. This allows for portability of the measures and mitigates most common data gaps. The RCMG team reviews all current HEDIS measures and assists our providers with methodologies designed to improve their quality of care scores.
Innovative clinic solutions
RCMG is dedicated to advancing opportunities in care access. We are a dynamic organization, active in the community to research and implement innovative programs that can create a more efficient provider process and a healthier member population. Our involvement includes the physicians with whom we partner to a wide array of services including surgical, social welfare and sub-specialist referrals.
One of our newest programs involves creating modular or part-time clinic environments designed to relieve pressure on the primary care and specialist networks while increasing timely access to medical services for patients.
In-Patient care management
In-Patient Care Management is one of the most effective and foundational programs in place at RCMG. Through our team of clinical staff we are able to impact key care metrics such as hospital readmission rates.
Signature Features of RCMG’s In-Patient Care Management Program:
- Dedicated program Clinical Case Managers
- Management of patient stay
- Same day reviews on all business days
- Active involvement with discharge planning back to network
- Follow up appointments made prior to discharge
- DME arranged for and delivered prior to discharge in most cases
- Experienced Physician Involvement
Out-Patient care management
Out-Patient Care Management is the basis of managed care. RCMG provides rapid decision making for our providers including sub-specialist referrals, diagnostic procedures and DME. Our highly trained nurses and physicians conduct rigorous medical review satisfying Medi-Cal regulatory guidelines for care management.
Features of RCMG’s Out-Patient Care Management Program:
- Coordination of care plan, including specialist pathways
- ER utilization analysis and high utilization identification
- High cost case analysis
- Member and caregiver education for Medi-Cal Guidelines
- Case Management, including complex case management
- CARE service department and one-call resolution
- Rapid review by Medical Director