• Handles inbound and outbound calls with members
• Reviews member records to ensure appropriate scheduling
• Schedules members for current campaigns
• Schedules member transportation as needed
• Documents outcomes as appropriate
• Collaborates with other departments in a cross functional manner
• Reviews accuracy and completeness of information requested and ensure that all supporting
documents are present
• Receives requests for pre-authorizations and ensures proper monitoring
• Processes prior authorization requests
• Manages correspondence with physicians, specialists and patients as required
• Conducts telehealth Case Management assessments, and documents the findings and responses in the applicable health management system within time allotted
• Communicated with physicians, discharge planners, and others to process referrals, authorization for services, and capture data related to member's needs
• Supervises multiple managed care teams, non-clinical and clinical operations in a call center
• Collaborates with Clinical Leadership to ensure program actions and outcomes align with clinical standards of care, decision making, and guidelines for referrals to clinical care resources
• Day-to-day professional support to Care Navigation and Care Coordination staff, to ensure efficient operation of the department; including compliance with policies and procedures, contractual obligations, and regulatory requirements
• Offers input, and assistance, with development of education and training programs
• Proficient in MS Office, Electronic Medical Records
• Administered medications and treatments as prescribed by physician
• Maintained records reflecting resident condition and treatment, including nurse's notes, discharge plans, resident assessments, and doctor's orders
• IV Pumps, Enteral Feedings, Electronic Medical Records