In this role, the selected candidate must have an experience working with individuals diagnosed with chronic conditions or pregnancy; strong working knowledge of Microsoft Word, Internet Explorer, and proficient typing skills.
In this role, you will be helping Obtain initial authorizations from HMO's / Medical Groups, managing referrals and negotiating with HMO and managed care Case Managers, Tracking and managing care provided to ensure maximum efficiency, proactive and effective service provided to Residents with skilled healthcare needs and performing a key leadership role during managed care plan meetings.
In this role, the selected candidate will develop the success of your team through coaching, providing clinical escalation support, process improvement and vision-setting; deliver on KPIs involving both member experience, satisfaction, and health outcomes, as well as employee experience and satisfaction.
In this role, the selected candidate will act in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan; effectively communicates the plan across the continuum of care.
In this role, you will evaluate the medical necessity and appropriateness of care, optimizing patient outcomes. Assesses patient admissions and continued stay utilizing standard criteria. Identifies issues that may delay patient discharge and facilitates resolution of these issues.