This position maintains and enhances Health plan (s) satisfaction through ongoing internal and external communication and education. 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 all CareCentrix departments, Health plans, Referral sources and CareCentrix providers. Supports data collection to report client audits, tier escalations, root cause analysis, and client meetings. Supports Account Management in client meetings, client communications and other client facing activities as needed and directed by the Account Management team or Client Service leadership. Works under the moderate direction from the Client Services, Clinical Manager. Director or AVP.
• Promotes collegial relationships with hospital designees, employer groups, IPAs, and health plan case managers to support discharge needs.
• Acts as a CareCentrix subject matter expert to assigned clients including but not limited to: health plans, employer groups, IPAs, and hospital designees and to provide educational opportunities on policy and process associated with the discharging facilities, to ensure appropriate levels of care are consistently met.
• Coordinates and provides education to hospital discharge planners and other referral sources to ensure understanding of CareCentrix’ role and responsibilities, as well as maintain customer satisfaction with key stakeholders in the referral process.
• Works with other departments for data collection for reporting activities, including issue resolution reporting, tier reporting, root cause identification and quality improvement activities.
• Provides telephonic and on-sight education to assigned Health Plans and other clients as needed.
• Participates in special projects and performs other duties as assigned.
This position is located in the Pittsburgh, PA area. You will be required to be on-site at our clients facility in Pittsburgh, PA
Successful candidate must possess a current RN license and able to practice without restriction, and have a minimum of one years’ experience in a managed care environment. Additional experience in home healthcare 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 but not limited to Word and Excel are required. Knowledge of Utilization Management and URAC standards is helpful.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.