Description Are you searching for a fulfilling role that can make a significant difference in healthcare? At Innovista, we're devoted to driving transformative change in this essential sector. Our independent physician partners achieve exceptional results in every aspect of value-based care, contributing to enhanced patient care and improved practice outcomes. Innovista Health is a full-service management services organization with a commitment to revolutionizing practice, offering solutions like multi-payer program administration, quality, utilization, and care coordination services, as well as performance improvement insights and reporting. Innovista Health Solutions, based in Illinois, is an organization with a far-reaching influence, operating in both Illinois and Texas. At Innovista, we trust in the power of innovative programs and dedicated people to propel us forward in today's ever-changing healthcare market. This fully remote position is a fantastic opportunity for you to become a part of our Houston, TX team, leading the charge toward a superior, more efficient healthcare system. JOB SUMMARY: Provide internal support to the Medical Management Department in the areas of Outpatient Case Management ensuring all services referred are reviewed according to plan requirements and approved criteria. DUTIES AND RESPONSIBILITIES: - Effectively communicates to management and internal departments timely. - Receives and responds to all incoming calls from PCP, specialists, and other providers regarding inpatients, surgeries, and outpatient services including DME, Home Health Care, and other services requiring a pre-authorization. - Coordinates DME with contracted HMO vendors for outpatient services. - Coordinate with Inpatient Case Manager on discharge planning of members (DME, Home Health, and Skilled Nursing). - Coordinates and reviews retro surgical procedures with Manager. - Understands Health Plan policies and procedures regarding pre-authorization, benefits by health plan, and preferred facilities within each plan. - Enters data and coordinates elective admissions with a surgical component. - Maintains compliance with all health plan guidelines on the reporting of cases/surgeries. - Works with clinical staff to assess benefit levels for non-medical denial determination to ensure the denial process includes letter and log maintenance. - Identifies potential stop-loss candidates to be monitored and reports to a senior-level manager. - Applies Innovista guidelines and additional approved criteria as detailed in the client UM Plan for the length of stay/admission criteria to approve initial and continued inpatient services. - Other duties as assigned. Requirements - High School Diploma or equivalent experience required. - At least 2-3 years of relevant professional experience, including managed care and quality. - Being knowledgeable in using InterQual and/or MCG (Milliman) guidelines is a plus. - Able to effectively communicate technical concepts and basic business concepts with team members and internal customers. BENEFITS: At Innovista, we prioritize attracting talented individuals who embody our core values of integrity, determination, and teamwork. We understand the significance of balancing personal life with work commitments and hence offer a comprehensive benefits package to support our team. Our offerings include: - A robust health benefits package with subsidized medical insurance, including Flexible Spending Account (FSA), Health Savings Account (HSA), and Health Reimbursement Account (HRA) options, complemented by dental and vision coverage. - Assurance of financial security with company-paid benefits such as short and long-term disability, employee life, and Accidental Death and Dismemberment (AD&D) policies. - A yearly discretionary bonus, enhancing your financial prospects. - A generous paid time off policy that appreciates and rewards your loyalty and tenure with the company. - Paid company holidays and parental leave, ensuring time for relaxation and family. - Access to our Employee Assistance Program, supporting you in times of need. - A 401(k) scheme with a company match, supporting your future financial stability. - The opportunity for flexible work arrangements including remote or hybrid work, and potentially adjustable work hours. - Opportunities for continuous education, fostering personal growth and development. - A "Dress for Your Day" policy, promoting comfort and individuality. - Access to discounted gym memberships via medical coverage, promoting wellness and health. - Clear career advancement and growth pathways, recognizing your hard work and ambition. - Rewarding employee referral bonuses for expanding our team with like-minded individuals. - An open-door policy that encourages direct communication with our CEO and upper management, fostering transparency and inclusivity in our work culture.

Role Description This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Opportunities at Optum, in strategic partnership with Allina Health. As an Optum employee, you will provide support to the Allina Health account. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. This position is full-time (40 hours / week), Tuesday - Saturday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 3:00 pm - 11:30 pm CST. It may be necessary, given the business need, to work occasional overtime. We offer 6 weeks of on-the-job training. The hours of training will be 7:00 am - 3:30 pm CST, Monday - Friday. Primary Responsibilities: - Organizes and maintains health information records - Reviews electronic chart documentation ensuring correct patient, location, and no duplicate information - Manages requests for documentation and information - Scans and edits documents in the electronic medical record - Locates, logs, retrieves, files, and delivers medical records stored in various mediums and systems - Distributes reports and results - May train and mentor co-workers - Analyzes documentation and tracks completion to meet regulatory requirements - Promotes principles of health information accuracy, transparency, currency, accessibility, relevancy, and reliability - Other duties as assigned You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Qualifications - High School Diploma / GED - Must be 18 years of age OR older - 1+ years of customer service experience in a healthcare setting - Experience working with medical records - Experience with Microsoft Word, Microsoft Excel (create, edit, save documents and spreadsheets) and Microsoft Outlook (email and calendar management) - Ability to train for the first six weeks between Monday - Friday, 7:00 am - 3:30 pm CST - Ability to work an eight-hour shift between 3:00 pm - 11:30 pm CST, Tuesday - Saturday. It may be necessary, given the business need, to work occasional overtime Preferred Qualifications - 2+ years medical terminology experience - 2+ years of experience in health information management (HIM) Telecommuting Requirements - Ability to keep all company sensitive documents secure (if applicable) - Required to have a dedicated work area established that is separated from other living areas and provides information privacy - Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Requirements Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $17.98 - $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

Role Description The Health Information Specialist II (HIS II) supports Release of Information (ROI) processing in a remote, work-from-home capacity. This role is critical to ensuring the timely, accurate, and compliant fulfillment of medical record requests, including subpoenas and legal documentation, while safeguarding patient privacy and maintaining full HIPAA compliance. This is a production-based role requiring advanced ROI knowledge, strong problem-solving skills, and the ability to independently manage complex and high-risk requests. Key Responsibilities - Managing advanced and complex ROI requests, including subpoenas and legally sensitive records. - High-volume ROI processing with a focus on accuracy, compliance, and timeliness. - Processing certified ROI requests and subpoenas in accordance with legal and regulatory standards. - Reviewing and validating authorizations, subpoenas, and court documents. - Utilizing EMR systems to retrieve, compile, and release medical records. - Ensuring all disclosures meet HIPAA, state, and client-specific requirements. - Maintaining detailed documentation and workflow tracking. - Supporting quality assurance initiatives and adhering to defined production metrics. - Communicating professionally with internal teams regarding escalations or complex cases. Qualifications - High School Diploma or GED required. - Must be 18 years of age or older. - Prior ROI experience required; subpoena experience strongly preferred. Requirements - Strong attention to detail with a high level of accuracy. - Advanced problem-solving skills to resolve complex ROI and subpoena-related issues. - Effective time management and ability to meet productivity standards. - Reliability, punctuality, and consistent schedule adherence. - Adaptability in a fast-paced, remote production environment. - Prior experience with subpoenas and legal ROI requests. - Comfortable working independently in a remote setting. - Ability to multitask and manage competing priorities. - Proficiency with computer applications, databases, and document management systems. - Strong organizational and documentation skills. - Clear, professional written and verbal communication. Benefits - Pay range: $16 - $20.50 USD per hour. - Post-offer health screenings and proof/completion of various vaccinations may be required. - Exemptions from health requirements may be available based on specific criteria.

Home infusion standard template Joining us is more than saying “yes” to making the world a healthier place. It’s discovering a career that’s challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individual expression in the workplace and thrive on the innovative ideas this generates. If this sounds like the workplace for you, apply now! We commit to respond to every applicant.