The Clinical Liaison maintains and enhances the Health plan's satisfaction through facilitating the resolution of issues essential in maintaining a collaborative relationship. The Clinical liaison educates and serves as a clinical resource and subject matter expert regarding the safe and appropriate use of home care. This role 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.
• 5 to 7 years’ experience required
• Educates the Health Plan(s) with the 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.
•Bachelor’s Degree required plus a minimum of
• 5 to 7 years’ experience in managed care, home care or related industry required.
• Clear and active Registered Nurse/LPN/LVN (based on allowable state practice act) license in any state(s) or jurisdiction in the United States is required.
• Computer skills, including Word, Excel and Outlook 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.