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Call Center Nurse Coordinator (LPN or RN)
Job ID: 2012-20139
# Positions: 10
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 8/24/2012
More information about this job:
New Hire Class to start 10/15/12 - Ability to work Mon - Fri from 10:30 am to 7pm.
JOB SUMMARY: Under general supervision, licensed clinician responsible for day to day telephonic medical management and pre-authorization activities. Manages member care ensuring essential, effective, appropriate and coordinated behavioral and physical health and social services. Acts as a member advocate, seeking and coordinating solutions to member health care needs.
1. Provides telephonic advice and education on the pre-authorization process to members.
2. Maintains and utilizes working relationships with and knowledge of referral sources and community resources.
3. Adheres to all company and state policies, accreditation standards and regulatory guidelines.
4. Utilizes the application of medical management criteria or other company designated criteria.
5. Acts as a clinical resource to other internal departments.
6. Communicates to assigned supervisor or leads all cases needing a higher level of intervention.
7. Documents all pre-certifications and authorization requests as well as all member encounters utilizing the appropriate systems and resources.
8. Utilizes leadership skills for non-clinical team members.
9. Collaboratively works with other departments.
10. Participates in Quality Improvement processes.
11. Performs other duties as assigned.
EDUCATION AND EXPERIENCE:
- High School Diploma or GED equivalent
- Associate's Degree in related Health/Nursing Field
- Bachelor's or Master's Degree in related Health/Nursing Field
Years and Type of Experience Required:Required:
- 2 Years experience as a licensed RN or 3 years experience as a licensed LPN/LVN in the Health Care or Managed Care Industry
- Experience working on the community level and with community agencies
Certifications or Licensures Required:
- LVN or LPN
Language Skills Required:
- Technical Competencies: Computer Hardware, Software, and Applications/ Office Equipment-Intermediate
- Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.
Communication Skills: Verbal, Written and Call Handling
- Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
- Skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.
- Ability to prepare, edit and convey a variety of messages including presentations, training materials and updates. Ability to handle escalated issues to diffuse concerns through verbal and written messages.
Heath Care Industry terminology
- Ability to understand basic health care industry terms. Ability to understand how an insurance claim works and use the explanation of benefits to explain details to providers.
Read, Interpret and Apply information
- Ability to read and comprehend information and provide detailed explanation to the business partner or customer that is accurate and appropriate.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
Medical Terminology and Anatomy
- Understand medical terminology to review clinical certifications. Hands on clinical skills to understand the workings of the human body to review and apply clinical criteria to certifications.
Strategic Leadership Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.
Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.
People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.
Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.
Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.
PHYSICAL REQUIREMENTS: The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone
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