This position maintains and enhances Health plan(s) satisfaction through facilitating the resolution of issues essential in maintaining a collaborative relationship Educates and serves as a clinical resource and subject matter expert regarding the safe and appropriate use of home care. Supports and serves as a resource to the Regional Care Centers, Health plan (s), referral sources and CareCentrix providers.
• Serves as a clinical resource to insure the safe, timely and appropriate use of home care, home infusion therapy and home medical equipment.
• Works with Health Plan(s) Managers, including, but not limited to Medical Directors in the coordination of complex home healthcare needs.
• Educates the Health Plan (s) to CareCentrix process, procedures and changes as it relates to member issues
• Collaborates with Health Plan(s) staff to insure appropriate compliance with Health Plan (s) guidelines and pre-certification requirements.
• Acts as a liaison between CareCentrix Care and Service Centers and the Health Plan (s) to promote collaboration and resolution regarding issues or concerns.
• Coordinates resolutions regarding quality of care and services issues with Quality Improvement, embracing and practicing the principles of quality to insure and help restore excellent care and service.
• Collaborates with the Health Plan (s), CareCentrix Care and Service Centers, and Provider Operations on issues related to provider availability and timely initiation of services.
• Provides telephonic and on-sight support to assigned Health Plan (s) offices as required.
• Assists the Revenue Cycle Management Department (RCM) on billing and claims issues as needed.
• Participates in special projects and performs other duties as assigned.
Bachelor’s Degree required plus a minimum of 5 to 7 years’ experience required. Current active RN license without restrictions plus a minimum of five years’ experience in managed care, home care or related industry required. Excellent verbal and written communication and presentation skills, ability to prioritize daily activities in a fast paced environment applying critical thinking, and a commitment to the principles and practices of Process Improvement. Computer skills, including Word, Excel and Outlook required. Knowledge of Utilization Management and URAC standards is helpful.
This is a client facing position with regular visits to our clients facility. The ideal candidate will have to be located within proximity of Pittsburg, PA.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.