Job Closed
This listing is no longer active.
Creating remarkable health experiences, freeing people to be their best.
Assoc Care Management Coord
Location
United States
Posted
99 days ago
Salary
$19 - $27 / hour
No structured requirement data.
Job Description
Assoc Care Management Coord
Highmark Health
Company : Highmark Inc.Job Description : JOB SUMMARY Perform accurate and timely processing of pre-certification requests for authorization of medically necessary health care services at the appropriate level of care, based on the benefits for the line of business, and in compliance with Gateway policies, procedures and regulatory requirements. Document, process and route requests for services to the nurse reviewer and other departments based on documentation procedures, including review type, clinical information, and decision timeframes. Follow policies and procedures to assure case completion and compliance with state and federal regulatory agencies. Maintain or exceed department standards for call volume, response time and related production and quality measures. May interact with other departments and providers to resolve cases. ESSENTIAL RESPONSIBILITIES: - Communicate effectively - Proactively inform designated individuals of the status of work assignment to assure decision timeframes and notification requirements are met - Communicate effectively with Utilization Management Staff, providers, other internal and external customers and management - Route Cases Based on Established Guidelines - Provide accurate and timely routing of service requests to the nurse reviewer to assure that the decision and notification timeframes are in compliance with regulatory guidelines - Process service requests meeting established guidelines, and document and route requests that are not permitted - Request additional information verbally and in writing when the information provided is not adequate to make a medical necessity determination - Maintain or exceed department call center standards - Adhere to line of business phone standards to assure regulatory requirements are met - Utilize phone functions to monitor the number of calls in queue and wait time - Utilize daily phone standard reports to assess opportunities for self improvement - Meet or exceed standards for other production and quality measures - Other duties as assigned or requested. QUALIFICATIONS Preferred - High School Diploma / GED - Experience in customer service - Experience in typing, keyboard and computer skills - Work experience in medical terminology - Associates degree or certification in a health related occupation - Work experience with ICD-9 and/or CPT coding Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $19.27 Pay Range Maximum: $27.42 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Related Guides
Related Categories
Related Job Pages
More Administration Jobs
Scheduled Hours 40 Position Summary Position works either remotely or in an area with no patient contact and performs secretarial duties, such as typing medical dictation, preparing spreadsheet/report formats, filing, etc. Job Description Primary Duties & Responsibilities: - Types reports, agendas and other documents using PC-based software for scheduling, spreadsheet analysis, budget/finance reports, clinic statistical data, etc. - Transcribes medical documents, such as letters, correspondence, medical record notes, nurse's notes and manuscripts. - Maintains medical records and notes. - Answers telephones, takes messages and forwards to appropriate persons. - Maintains the daily appointment schedule for visitors and patient office visits. - Maintains file system, including retrieval, copy and disposal of files. - Maintains memberships, societies, licensures and curriculum vitae. - Coordinates programs, such as residency, student clerk-ship work-study services and interoffice clerical functions. - Assists administrative/physician staff during peak times, vacations/illnesses. - Greets visitors and routes incoming mail. - Performs other duties as assigned. Working Conditions: Job Location/Working Conditions: - Normal office environment. Physical Effort: - Typically sitting at desk or table. Equipment: - Office equipment. The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time. Required Qualifications Education: High school diploma or equivalent high school certification or combination of education and/or experience. Certifications/Professional Licenses: No specific certification/professional license is required for this position. Work Experience: Medical Office Setting (2 Years) Skills: Not Applicable Driver's License: A driver's license is not required for this position. More About This Job Preferred Qualifications: - Ability to type and use various software packages, set up spreadsheet/report formats and working knowledge of medical terminology. - Effective verbal, written and interpersonal communication skills. - Proven decision-making skills and ability to work independently. - Working knowledge of general office equipment and computers (specifically Microsoft Office). Preferred Qualifications Education: No additional education unless stated elsewhere in the job posting. Certifications/Professional Licenses: No additional certification/professional licenses unless stated elsewhere in the job posting. Work Experience: No additional work experience unless stated elsewhere in the job posting. Skills: Communication, Decision Making, Medical Terminology, Microsoft Office, Results Reporting, Spreadsheets, Working Independently Grade G06-H Salary Range $17.87 - $27.06 / Hourly The salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget. Questions For frequently asked questions about the application process, please refer to our External Applicant FAQ. Accommodation If you are unable to use our online application system and would like an accommodation, please email CandidateQuestions@wustl.edu or call the dedicated accommodation inquiry number at 314-935-1149 and leave a voicemail with the nature of your request. All qualified individuals must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. Pre-Employment Screening All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening. Benefits Statement Personal - Up to 22 days of vacation, 10 recognized holidays, and sick time. - Competitive health insurance packages with priority appointments and lower copays/coinsurance. - Take advantage of our free Metro transit U-Pass for eligible employees. - WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%. Wellness - Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more! Family - We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We’ve got you covered. - WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us. For policies, detailed benefits, and eligibility, please visit: https://hr.wustl.edu/benefits/ EEO Statement Washington University in St. Louis is committed to the principles and practices of equal employment opportunity. It is the University’s policy to provide equal opportunity and access to persons in all job titles without regard to race, ethnicity, color, national origin, citizenship (where prohibited by federal law), age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.
Scheduling Specialist
Gundersen Health SystemBased in LaCrosse, Wisconsin, the Gundersen Health System is a physician-led, nonprofit healthcare network with facilities in 19 counties throughout western Wis
Love + medicine is who we are, it's what we do, it's why people want to work here. If you’re looking for a job to love, apply today. Scheduled Weekly Hours: 36 We are hiring for a Scheduling Specialist in our Therapy unit! Emplify by Gundersen Health is seeking a motivated individual with strong phone etiquette, excellent interpersonal and communication skills, and a high level of attention to detail. This role requires the ability to multitask effectively while providing exceptional service. The Scheduling Specialist works directly with patients and is responsible for accurately scheduling appointments. What's Available: - 0.9 FTE (72 hours biweekly) - Shift: Monday-Friday, Days (8:30 AM- 5:00 PM) **No Weekends**, nine 8-hour shifts with one day off during the week in a two week period - Location: Onalaska, WI, - remote eligible after training - Department: Therapy What you will do: - Provide LOVE + MEDICINE to our patients through providing the best first/last impressions with top level customer service. - Partner with a team of providers, medical professionals and managers who are here to support your success and that of our patients in their health journeys. - Provide customer service to patients by helping schedule appointments What you will get: - Starting pay of $17.54/hour + more for experience! - Support to grow in your career with access to our Career Development Center and Tuition Investment Program - Top-rated retirement plan and healthcare benefits - Departmental leadership that supports you as you do your best work. - Work/Life balance to love what you do and where you live. What you need: - High School Diploma or equivalency - 1 year experience in an office setting requiring customer service responsibilities - Strong organization and communication skills Emplify Health is comprised of two of the Midwest’s most respected healthcare systems, Bellin Health and Gundersen Health System. Once neighbors, we are now partners, united in our mission to provide exceptional care to our communities. As a not-for-profit, patient-centered healthcare network, we have headquarters in Green Bay and La Crosse, Wisconsin. Our extensive network includes 11 hospitals and more than 100 clinics, serving 67 cities and rural communities across Wisconsin, Iowa, Minnesota and Michigan’s Upper Peninsula. With over 4,500 dedicated nurses and providers, we are committed to delivering primary, specialty and emergency care, along with innovative medical education programs. Join us in making a meaningful difference in the lives of our patients and communities. If you need assistance with any portion of the application or have questions about the position, please contact HR-Recruitment@gundersenhealth.org or call 608-775-0267. We inspire your best life by relentlessly caring, learning and innovating. This is our purpose. Together with our values — belonging, respect, excellence, accountability, teamwork and humility — our pillars set our foundation and our future. Equal Opportunity Employer
• Manage and optimize databases, ensuring data integrity, security, and efficiency. • Perform maintenance on corporate data models. • Audit data models to ensure compliance with data management standards. • Execute DDL scripts on development and test database servers. • Validate data models and DDL scripts based on the client's database standards. • Restore databases to development and test servers. • Apply permissions to database objects appropriate for development and test computing environments. • Install and upgrade versions on development and test servers. • Optimize query and application database performance. • Perform maintenance on database servers within the development and test perimeters. • Ensure data quality standards according to Database Standards and Guidelines. • Maintain data masking and/or de-identification routines in accordance with internal policies and applicable legislation.
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The National Telestroke Program (NTSP) Registered Nurse Coordinator (RNC) is responsible for nurse triage and program coordination responsibilities. This is a 100% virtual position that provides telehealth services within the VA NTSP. - Provides telehealth triage services for acute ischemic stroke (AIS), subacute, and transient ischemic attack (TIA) based on NTSP triage protocols. - Facilitates telehealth connection between NTSP stroke neurologist and receiving facility providers based on AIS/TIA acuity and NTSP triage protocols. - Documents triage encounters in the NTSP Call Log and electronic medical record. - Provides care in the least restrictive, most cost-effective manner through use of established AID clinical practice guidelines and clinical pathways. - Follows up on admitted cases from the prior workday to assess Veterans' needs and continues to monitor, track, and intervene as necessary. - Contributes to the delivery of Telestroke inpatient and/or outpatient care/services as NTSP expands services. - Promotes continuity of care through communication and proficient electronic medical record documentation. - Demonstrates the ability to multi-task in a timely manner using all technology embedded support systems. - Utilizes effective communication skills to collaborate and co-manage Veterans' care. - Demonstrates leadership in delivering and improving Telestroke care. - Demonstrates sound judgment, critical thinking, and strong decision-making skills. - Shows strong ability to function proactively and independently, as well as with team members. - Consistently demonstrates excellent customer service and appropriate telehealth etiquette. Qualifications - English Language Proficiency. - Graduate of a school of professional nursing approved by the appropriate accrediting agency. - Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth of the United States. - Graduate Nurse Technician (GNT) Exception may apply. Requirements - Basic education requirements must be met for the grade held. - Grade Determinations based on Scope, Education and Dimension criteria. - Preferred Experience: Telehealth Program and Nursing Education in Stroke Care. Informatics experience is a plus. Benefits - Competitive salary, regular salary increases, potential for performance awards. - 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays). - Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA. - Federal health/vision/dental/term life/long-term care insurance options. - Work Schedule: 8:00am-4:30pm, Monday through Friday. - Telework: Not Available; This is a remote position.


