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Are you an experienced Registered Nurse with a passion for shaping the future of healthcare? Our Post-Acute Care team at CareCentrix is committed to making the home the center of patient care.
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. Responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site initial face to face outreach with patients to introduce the Post-Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. You 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.
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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.
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The Post-Acute Care Program assists with reducing hospital readmissions of clinically complex patients. The program couples patient education/coaching with Home Health interventions to assist a patient’s transition home after a hospital stay. Staff works directly with patients in transitioning from hospital to home with a focus on short term self-recovery in the home and long term ongoing care management of their healthcare. Assess patients care needs through assessments that are completed in home and/or telephonically, treatment plan creation to mitigate care gaps, facilitate in home health care services to accomplish the treatment plan patient goals, patient education/coaching along with adherence/compliance monitoring.
This position functions as the Supervisor of the Post-Acute Care team and primary point of contact for day to day clinical questions, concerns from internal and external clients and provides team leadership and guidance regarding patient centered interventions. Assists in development of Post-Acute Care training, job aids and tools and desk level procedures. Provides clinical oversight for the PAC Nurse Liasions.
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Are you an experienced Registered Nurse with a passion for shaping the future of healthcare? Our Post-Acute Care team at CareCentrix is committed to making the home the center of patient care.
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. Responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site initial face to face outreach with patients to introduce the Post-Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. You 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.
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As a Clinical Reviewer, you will be responsible for the review of clinical information for service requests received and render a medical necessity approval or recommended denial to the Medical Director. You will evaluate information concerning patient care and match those needs with available care options, consistent with CareCentrix guidelines and specific plan payer criteria. You will review referrals for medical necessity and determine approval or elevation to the Medical Director. You will own the case from point of referral to the recommendation for denial, or approval decision. If a request is to be denied, you will complete the denial process in collaboration with the Medical Director; if a request is to be authorized, it will then be sent onto the staffing department for completion when appropriate.
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Facilitates new hire, customer service, systems, business processes, and new initiative training for all clinical operational business unit. Works closely with the business to ensure that associates receive effective on-the-job training support. Position requires facilitation skills and the ability to provide coaching and feedback.
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This leadership position will develop and manage market specific relationships with acute and post-acute facilities, home health agencies, physician groups, accountable care organizations (ACOs) and integrated delivery networks (IDNs). As the Director of Market Engagement you will evaluate the market dynamics, communicate with market leadership and collaborate with hospitals, skilled nursing facilities, home health agencies and at risk providers to influence key value drivers and improve the delivery of post-acute care. The Director monitors key metrics and supports acute and post-acute initiatives that will improve outcomes, enhance provider and patient satisfaction and achieve overall program performance targets. You will also assist in identifying strategic relationships and solutions, alternative PAC delivery models, and other activities focused on creating value for the CareCentrix payor and provider community.
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Come make a difference with a growing organization that is helping to shape the future of healthcare! CareCenrix is committed to making the home the center of patient care.
This position will be part of the Linux Administration team responsible for managing our middleware tier on RedHat Linux in a virtualized environment utilizing VMware. This position will work closely with other teams – Windows, Network, VMWare, Database and Security to maintain and seek ways to advance capabilities including expanding into the cloud infrastructure.
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This leadership position will develop and manage market specific relationships with acute and post-acute facilities, home health agencies, physician groups, accountable care organizations (ACOs) and integrated delivery networks (IDNs). As the Director of Market Engagement you will evaluate the market dynamics, communicate with market leadership and collaborate with hospitals, skilled nursing facilities, home health agencies and at risk providers to influence key value drivers and improve the delivery of post-acute care. The Director monitors key metrics and supports acute and post-acute initiatives that will improve outcomes, enhance provider and patient satisfaction and achieve overall program performance targets. You will also assist in identifying strategic relationships and solutions, alternative PAC delivery models, and other activities focused on creating value for the CareCentrix payor and provider community.
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Come join a dynamic, growing team in an innovative, game-changing, healthcare organization! CareCentrix is committed to making the home the center of patient care.
As a Business Intelligence Developer, you will be responsible for pulling and aggregating data from multiple disparate systems, building and supporting enterprise level BI and Analytic solutions that will enable business users to make informed business decisions and help foster a data driven culture. The individual will work closely with business stakeholders to gather requirements, consulting as the data subject matter expert, design and develop reports and dashboards, create and execute ad-hoc queries against CareCentrix’s data warehouse and operational systems. This individual is specifically being brought on to help with enhancements, new reports, and functionalities, as well as issues and requests received in the form of tickets. In this role, you should have a background in data and analytics, be an excellent communicator and be passionate about what you do.
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Post-Acute Care (PAC) Program is an end-to-end post-acute offering that manages up to 90-day episodes of care, beginning prior to the patient’s discharge from the hospital, or for elective surgical cases, outreach begins prior to hospitalization. The program optimizes our home-based network, identifies the likely best site-of-care for the patient, manages length of stay (LOS) if a Skilled Nursing Facility (SNF) is appropriate, and reduces hospital readmissions. Our program also coordinates all of the services required for a patient to transition to their home faster and safer, via our network of home health, durable medical equipment and home infusion providers, all of whom are supported by our CareCentrix care coordination team.
POSITION SUMMARY
The Nurse Liaison is responsible for an assigned caseload at acute and post-acute care facilities. The Nurse Liaison will conduct in person, on site initial face to face outreach with patients to introduce the Post Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. The Nurse Liaison 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.
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As the Director of Utilization Management you will provide leadership and oversight of clinical and utilization management (UM) activities for programs in accordance with company policies and procedures. Works with the CareCentrix corporate UM department and the operations management team to develop, implement and manage effective UM initiatives designed to position CareCentrix as an industry leader for excellent clinical outcomes by obtaining optimal financial results for CareCentrix and their customers.
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Post-Acute Care (PAC) Program is an end-to-end post-acute offering that manages up to 90-day episodes of care, beginning prior to the patient’s discharge from the hospital, or for elective surgical cases, outreach begins prior to hospitalization. The program optimizes our home-based network, identifies the likely best site-of-care for the patient, manages length of stay (LOS) if a Skilled Nursing Facility (SNF) is appropriate, and reduces hospital readmissions. Our program also coordinates all of the services required for a patient to transition to their home faster and safer, via our network of home health, durable medical equipment and home infusion providers, all of whom are supported by our CareCentrix care coordination team.
POSITION SUMMARY
The Nurse Liaison is responsible for an assigned caseload at acute and post-acute care facilities. The Nurse Liaison will conduct in person, on site initial face to face outreach with patients to introduce the Post Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. The Nurse Liaison 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.
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The Post-Acute Care Program assists with reducing hospital readmissions of clinically complex patients. The program couples patient education/coaching with Home Health interventions to assist a patient’s transition home after a hospital stay. Staff works directly with patients in transitioning from hospital to home with a focus on short term self-recovery in the home and long term ongoing care management of their healthcare. Assess patients care needs through assessments that are completed in home and/or telephonically, treatment plan creation to mitigate care gaps, facilitate in home health care services to accomplish the treatment plan patient goals, patient education/coaching along with adherence/compliance monitoring.
This position functions as the Supervisor of the Post-Acute Care team and primary point of contact for day to day clinical questions, concerns from internal and external clients and provides team leadership and guidance regarding patient centered interventions. Assists in development of Post-Acute Care training, job aids and tools and desk level procedures. Provides clinical oversight for the PAC Nurse Liasions.
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Reviews system documentation and listens to phone calls on a daily basis to conduct individual audits specific to the functional area as indicated by auditing tools and procedures. Complies and generates reports on individual and departmental level trends and discusses results with leadership. Analyzes data and processes and facilitates small teams to identify root causes. Develops recommended action plans using in collaboration with department leadership.
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The LMS Administrator is responsible for the administration of training content for internal users of the Learning Management System (LMS). The LMS Administrator is responsible for the design, development, implementation, delivery, and maintenance of content, assets, and other resources used for instructional functions. Including, but not limited to system updates and upgrades, as well as tools and software integrated with the LMS. Additionally, the LMS Administrator provides administrative support and accountability for the LMS including daily administration, reporting, employee inquiries/education on the LMS, and consult with internal customers serving as the subject matter expert for continuing operations of the system to serve the learning needs of the organization.
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Are you an experienced Registered Nurse with a passion for shaping the future of healthcare? Our Post-Acute Care team at CareCentrix is committed to making the home the center of patient care.
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. Responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site initial face to face outreach with patients to introduce the Post-Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. You 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.
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The AVP will manage assigned CareCentrix accounts as the primary client manager and point of contact and establish a positive working relationship with multiple-level-managers within the account. The AVP is accountable for the overall service and delivery for all assigned clients and will coordinate with relevant external and internal functional areas to ensure that the needs of the client are being met. The AVP will ensure that all Client performance standards and all contractual commitments are met or exceeded and will escalate critical client concerns to VP for resolution or consultation. This position will manage retention, upselling, and renewal activity of assigned accounts and is responsible for meeting specific revenue and growth targets as assigned for each account.
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Are you an experienced Registered Nurse with a passion for shaping the future of healthcare? Our Post-Acute Care team at CareCentrix is committed to making the home the center of patient care.
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. Responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site initial face to face outreach with patients to introduce the Post-Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. You 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.
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Are you an experienced Registered Nurse with a passion for shaping the future of healthcare? Our Post-Acute Care team at CareCentrix is committed to making the home the center of patient care.
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. Responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site initial face to face outreach with patients to introduce the Post-Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. You 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.