Are you an experienced Registered Nurse with a passion for shaping the future of healthcare?   As a Nurse Liaison you will be an expert in resource management, a master of utilization review and a compassionate partner for patients and their support network. You will be responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site, face to face outreach, with patients to introduce the Post-Acute program. You will gather patient demographics and collaborate with hospital clinicians, patients and their family to develop a discharge plan of care and will coordinate post-acute care services for the patient and collaborate with Post-Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.   The Post-Acute Care program helps to reduce hospital readmissions of patients and has aspects of education and coaching to assist patient’s transition home after a hospital stay. The program works directly with patient treatment plans, facilitates in home health care services to accomplish the treatment plan, patient goals and patient education/coaching along with adherence/compliance monitoring.

This position provides comprehensive Human Resources support to a designated business area.  This role will actively participate in departmental strategic planning activities to meet business objectives and consult with customer leadership to assess staffing, training and development needs, organizational effectiveness needs; consults on employee relations issues/EEO/AA compliance, recommends solutions to compensation and performance management issues, and assists in developing/interpreting and applying HR policies to help Associates move through organizational redesign and change. Works under general direction.  

As the Sr. Manager – Enterprise Support Services, you will be responsible for first and second level Help Desk support. The scope of duties encompasses the day-to-day operations/staffing, triage and resolution of first and second level problems/requests. You will be responsible for the management of external vendors with regard to help desk services and support and ensure adherence to contractual agreements with regard to the provision of those services. You will collaborate extensively with internal customers to ensure operational efficiency and efficacy.  

The Clinical Utilization Management Supervisor oversees the team that handles the denial review process for UM Operations. The department’s activities include; serving as a resource for utilization management program and clinical guideline application assisting with clinical data collection, analysis and reporting, supporting operations and management team with clinical feedback and utilization training, tracking and monitoring turnaround times to assure service requirements are met, coordinating with operations and clinical team members to intervene when service levels are at risk, providing appropriate issue resolution and/or escalation when necessary, assuring timely letter generation and mailing, and coordinating the with Quality Department in preparation for internal and customer audits. The Clinical Utilization Management Supervisor ensures that the denial and physician review process and turnaround times are in compliance with customer, regulatory and accrediting agency standards, and CareCentrix standards and policies. Trains new team members and performs ongoing training of existing team. Monitors performance of team and individual members and takes appropriate action to ensure department goals are met.

This position supervises a team of non-exempt associates within assigned unit in Operations. Monitors performance and productivity of individuals and the team and takes appropriate action to ensure department goals are met including, but not limited to regular scheduled and just-in-time coaching, recommending re-training, performance management and mentoring associates. Manages payer, provider and patient complaint resolution. Consistently identifies areas of opportunity/process improvement within department and recommends solutions as necessary.  

As the Senior Director of Sales Strategy you will be the strategic advisor for the sales organization, responsible for managing a complex consultative sales process across many stakeholders within CareCentrix. This role is responsible for leading and coordinating all internal sale activities while providing strategic oversight to ensure proposals are creating the optimal value for clients and CareCentrix. Dynamic, analytic team player who has a strong background working in the complex healthcare ecosystem needed.  

Do you have the passion to make an impact on people’s lives? Then come join our team! CareCentrix is committed to making the home the center of patient care.   As an Operations Specialist, you will manage, perform, organize, and streamline Customer Care Center operational tasks.  You will interact with clients, providers, and internal partners to provide information and resolve problems.

Are you an experienced Registered Nurse with a passion for shaping the future of healthcare?   As a Nurse Liaison you will be an expert in resource management, a master of utilization review and a compassionate partner for patients and their support network. You will be responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site, face to face outreach, with patients to introduce the Post-Acute program. You will gather patient demographics and collaborate with hospital clinicians, patients and their family to develop a discharge plan of care and will coordinate post-acute care services for the patient and collaborate with Post-Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.   The Post-Acute Care program helps to reduce hospital readmissions of patients and has aspects of education and coaching to assist patient’s transition home after a hospital stay. The program works directly with patient treatment plans, facilitates in home health care services to accomplish the treatment plan, patient goals and patient education/coaching along with adherence/compliance monitoring.

As a Lead Analyst on our Business Technology (BT) Operations team you will influence the next wave of intelligence reporting.  You will gather requirements, design reports and dashboards on corporate technology metrics, and provide trend analysis and commentary.  You will be the owner of BT metrics and KPIs to ensure there is alignment to the department’s data and reporting.  Your responsibilities also include post analysis work to monitor and ensure the new tools implemented provide the proper visualization of key metrics so these are leveraged for improved decision making. Building a comprehensive understanding of business process of the associated data and applications is essential to succeed in this role.  

Lead CareCentrix’s Home Health Product Analytic activities and be accountable for setting a standard methodology and process for performing strategic analysis and executing according to that standard.  You will collaborate with other CareCentrix departments, including finance, product development, account management-sales, provider services, technical solutions group, and performance improvement to optimize profitability, growth, and operational performance.

Are you an experienced Registered Nurse with a passion for shaping the future of healthcare?   As a Nurse Liaison you will be an expert in resource management, a master of utilization review and a compassionate partner for patients and their support network. You will be responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site, face to face outreach, with patients to introduce the Post-Acute program. You will gather patient demographics and collaborate with hospital clinicians, patients and their family to develop a discharge plan of care and will coordinate post-acute care services for the patient and collaborate with Post-Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.   The Post-Acute Care program helps to reduce hospital readmissions of patients and has aspects of education and coaching to assist patient’s transition home after a hospital stay. The program works directly with patient treatment plans, facilitates in home health care services to accomplish the treatment plan, patient goals and patient education/coaching along with adherence/compliance monitoring.

As an Inside Sales Representative, you play a key role in CareCentrix’s prospecting and lead generation efforts. You will help build the sales pipeline for the sales team through outreach to prospective customers, supporting our mission of empowering health at home.  This role will interact with all levels of management.

As the SVP, Network Strategy and Engagement you will serve as the organizational leader for Network Strategy and Engagement. Responsible for overseeing relationships with providers.  Collaborates with internal stakeholders to advance Company's network agenda and goals. Provides strategic leadership, as well day-to-day responsibility for decisions, for CareCentrix programs and products related to network solutions.

Are you an experienced Registered Nurse with a passion for shaping the future of healthcare?   As a Nurse Liaison you will be an expert in resource management, a master of utilization review and a compassionate partner for patients and their support network. You will be responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site, face to face outreach, with patients to introduce the Post-Acute program. You will gather patient demographics and collaborate with hospital clinicians, patients and their family to develop a discharge plan of care and will coordinate post-acute care services for the patient and collaborate with Post-Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.   The Post-Acute Care program helps to reduce hospital readmissions of patients and has aspects of education and coaching to assist patient’s transition home after a hospital stay. The program works directly with patient treatment plans, facilitates in home health care services to accomplish the treatment plan, patient goals and patient education/coaching along with adherence/compliance monitoring.

Do you have the passion to make an impact on people’s lives? Then come join our team! CareCentrix is committed to making the home the center of patient care.   The Workforce Management Senior Analyst position is an individual contributor role that works as part of a team generating forecasts and schedules and performing analytics on results. This is a job that requires a strong aptitude in mathematics and the ability to break down complex analytics into understandable and relatable terms to a wide variety of people. Through data preparation, tracking and analysis this position provides guidance and direction on workforce strategies across multiple departments to enhance performance and productivity while reducing costs.

As a Salesforce Developer you perform hands-on technical implementation, with a focus on delivering functional solutions on the Salesforce.com platform. You will take a lead role in the design, implementation, deployment and documentation of projects that leverage the Salesforce.com toolset. 

Responds to patient/financial responsible party calls effectively and provides exemplary customer service. Identify callers' needs; educate them on CareCentrix role in their care. Determines the acceptance of patient’s financial responsibility through claim research, plans, eligibility, notes, etc.; goal to resolve patient’s account. Identifies and escalates patient issues and concerns to the appropriate senior. Works under general supervision. Guides collectors in their performance of invoice processing activities to ensure receivables are reimbursed in an accurate and timely basis. Works directly with the payer, internal and external customers and other contract clients towards efficient and effective collection results. Works under moderate supervision.   PRIMARY RESPONSIBILITIES Collector • Ensures the coordination of invoice activities leading to timely reimbursement of receivables using available resources including databases, internet, and telephone. • Researches and resolves denials received that have not passed payer edits and may lead to a final appeal of denied services. Requires knowledge of a variety of system applications both internal and external. Determines and initiates action to resolve rejected invoices, prepares payer corrections, and/or appeals using electronic and paper processes. • Provides guidance, assistance, education, and communications with internal and external customers related to insurance and government payers claims processing protocols. • Utilizes various resources to determine patient’s eligibility, benefits, and health plan confirmation. Including online payer databases, CareCentrix Eligibility platforms, and medical records that may result in provider or payer recoup/rejection activity. • Oversees accounts receivable adjustments to resolve overpayments and payment rejections according to standard operating procedures. Analyzes and clears payment variances. May prepare adjusted and corrected bills or adjust accounts receivable entries in accordance with existing operating procedures. May include the use of special reporting. • Evaluates, analyzes and monitors the processing of invoices and on-line notes, utilizing a Windows based data processing system. Monitors payer responses, using Microsoft Excel, Microsoft Access and other software as necessary to ensure prompt payment. • Contacts providers, physicians, and/or patients to retrieve appropriate medical documentation to substantiate services provided and engage them in assisting CareCentrix in collecting for the payer. • Provide payers with detailed itemization of services performed to ensure timely reimbursement. Review EOPs/EOMBs/EOBs for accuracy of patient responsibility. • Provide input on accounts receivable process improvements and assisting in their implementation. • Prepares Ad Hoc financial reports for management to use in the evaluation of accounts receivable performance. • Participates in teleconferences covering a wide range of topics that enables the NBC to effectively collect account receivables. • Assist Lead Collector with training of newly hired associates and re-education of collection teams as necessary. • Acts as an information resource for hard to collect accounts and a “grey area” subject expert. Ensures the coordination of special handling or reconciliation of spreadsheets for national payers. • Monitors team results to ensure they are aligned with departmental goals. • Works with internal customers to identify issues which may result in new enhancements or platforms as necessary. • Assures the completion and coordination of work in an associate’s absence, or as needed to maintain departmental standards. • Participates in special projects and performs other duties as assigned. Patient Account Specialist • Researches, resolves, and documents patient inbound and outbound calls involving a wide range of issues utilizing multiple information systems. This includes communications with internal business centers and external customers. Assures customer agreement by summarizing and closing each call appropriately.  • Investigates payment status and determines ultimate patient financial responsibility. Collect outstanding balance, offer patient assistance with financial responsibility through various financial options. • Identifies overpayments, processes refunds, adjustments, and appeals as necessary. Analyzes and resolves payment variances, which may involve preparation of adjusted and corrected bills, or adjusting accounts receivable entries in accordance with existing operating procedures. This may include the use of special reporting. • Minimizes patient dissatisfaction by listening attentively, maintaining a professional tone, and acknowledging their concerns. Escalates patient issues and concerns to the appropriate senior. • Works with internal and external customers to obtain appropriate medical documentation, work orders, proof of delivery, or other documentation necessary to resolve open account issues. • Reviews payer payment explanation for accuracy of patient responsibility. • Exercises good judgment, interpret data, and remains knowledgeable in details of all related CareCentrix contracts, policies and procedures. Participates in process improvement initiatives; maintains teamwork, customer service production and quality standards to assure timely, efficient and accurate call resolution. • Maintain patient confidentiality and data integrity in accordance with Health Information Portability Accountability Act (HIPAA), and company policies and procedures. • Sends patient necessary documentation required to complete the payment arrangement process. Prepares payment plan agreements or other correspondence; including requests for secondary payers or Medicare/Medicaid verification or other documentation necessary to resolve open account issues. Assures patients return documentation or signed payment agreements. • Takes appropriate action when patient requests assistance in reconciling their financial responsibility, including proper follow up. • Participates in special projects and performs other duties as assigned.

This position receives/responds to incoming calls from referral sources/patients and communicates with providers for CareCentrix and contacts referral sources to advise them of referral status. Reviews utilization information concerning patient care for CareCentrix and matches those needs to available care options within the reauthorization guidelines provided by CareCentrix and patients’ health care. Assists the Supervisor and Manager with coaching, training, call monitoring, reports and mentoring of new associates. Acts as a clinical resource to department specialists, providing expertise and clinical knowledge. Negotiates with providers when needed and stay within the guidelines. Performs Utilization Management and participates in performance improvement activities (specific measurement for contracts). Works under moderate supervision.   - Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.   - Works collaboratively with Utilization Management Medical Director, Manger, and Supervisor(s).  - Assists Supervisor/Manager with coaching, training, call monitoring, reports and mentoring of new associates.   - Assigns and prioritizes clinical cases for team member review based upon clinical urgency and turnaround times. - Acts as a clinical resource for unlicensed Utilization Review Care Coordinators, providing clinical expertise and helping to clarify referral source directives. Receives/responds to requests from unlicensed staff regarding scripted clinical questions and issues.  - Makes on-going authorization decisions for health plans for which CareCentrix manages the reauthorization responsibilities. Issues service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines.  - Ability to negotiate with providers when needed and stay within the guidelines.   - Performs an evaluation of referral appropriateness for CareCentrix services.   - Researches/identifies all potential payer sources and determines the primary payer.   - Receives/responds to incoming calls from referral sources/ patients, exchanges information in order to identify the patient’s needs and assist in determining the Company's ability to meet them.   - Documents the outcome of calls and referral acceptance in an automated manner.  - Contacts referral sources to advise them of referral status. Relays referral and utilization information to the clinical team who will deliver the services requested.  - Access payer fact sheets to determine if the terms of the contract are covered. Works with the Patient Registration team, contracted providers and patients to identify potential solutions as clinical problems are identified with payer sources.   - Communicates customer service/provider issues to supervisor for logging and resolution.  - Participates in and contributes to ongoing utilization management activities and quality audits. Ensures the collection of data for improvement analysis and prepares reports as requested. - Assists team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.  - Participates in implementing / maintaining operational processes to ensure compliance to Company.  - Participates in special projects and performs other duties as assigned.

Are you an experienced Registered Nurse with a passion for shaping the future of healthcare?   As a Nurse Liaison you will be an expert in resource management, a master of utilization review and a compassionate partner for patients and their support network. You will be responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site, face to face outreach, with patients to introduce the Post-Acute program. You will gather patient demographics and collaborate with hospital clinicians, patients and their family to develop a discharge plan of care and will coordinate post-acute care services for the patient and collaborate with Post-Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.   The Post-Acute Care program helps to reduce hospital readmissions of patients and has aspects of education and coaching to assist patient’s transition home after a hospital stay. The program works directly with patient treatment plans, facilitates in home health care services to accomplish the treatment plan, patient goals and patient education/coaching along with adherence/compliance monitoring.

Are you an experienced Registered Nurse with a passion for shaping the future of healthcare?   As a Nurse Liaison you will be an expert in resource management, a master of utilization review and a compassionate partner for patients and their support network. You will be responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site, face to face outreach, with patients to introduce the Post-Acute program. You will gather patient demographics and collaborate with hospital clinicians, patients and their family to develop a discharge plan of care and will coordinate post-acute care services for the patient and collaborate with Post-Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.   The Post-Acute Care program helps to reduce hospital readmissions of patients and has aspects of education and coaching to assist patient’s transition home after a hospital stay. The program works directly with patient treatment plans, facilitates in home health care services to accomplish the treatment plan, patient goals and patient education/coaching along with adherence/compliance monitoring.