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Job ID: 2010-12140
# Positions: 14
Location: US-VA-Virginia Beach
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

The Care Coordinator in the Support Center and/or National Contact Center is responsible for day to day medical management or pre-authorization activities. This contact center position manages member care ensuring essential, effective, appropriate and coordinated behavioral and physical health and social services. This individual acts as a member advocate, seeking and coordinating solutions to member health care needs.

Responsibilities:

1. Provides telephonic advice to members.

2. Maintains and utilizes working relationships with and knowledge of referral sources and community resources.

3. Adheres to all company policies concerning the preauthorization process.

4. Utilizes the application of medical management criteria or other company designated criteria.

5. Educates members and providers on the authorization process, when indicated.

6. Adheres to all state, accreditation standards and regulatory guidelines.

7. Acts as a clinical resource to other internal departments.

8. Follows HIPAA guidelines, Call Center Call Quality Performance Standards and Guidelines for Aux Work Usage

9. Communicates to assigned supervisor all cases needing a higher level of intervention.

10. Documents all pre-certifications and authorization requests as well as all member encounters utilizing the appropriate systems and resources.

11. Requests direction from appropriate supervisor(s) on complex issues.

12. Utilizes leadership skills for non-clinical team members.

13. Collaboratively works with other departments.

14. Participates in Quality Improvement processes.

15. Serves on internal and external committees.

16. Maintains member confidentiality.

17. Other duties as assigned.

Qualifications:

Education

Required:

LVN or LPN (depending on State) required with minimum 1 - 3 years experience in health care.

Current State license to practice Nursing.

Preferred:

Bachelors or Master's Degree and/or RN and three years experience in health care.

Years and Type of Experience Required:

Preferred:

Experience working on the community level and with community agencies preferred.

Certifications or Licensure

Required:

Must possess a valid driver's license and access to a motor vehicle.

Other

Required:

Computer literate.

Excellent verbal and written communications skills.

Strong decision making skills.

Ability to provide services in an environment that involves multiple health care systems.

Ability to interact with all relevant components of the health care system.

Ability to provide services that deal with the individual's broad spectrum of needs.

Self-starter with ability to handle multiple projects at one time.

Appreciation of cultural diversity and sensitivity towards target population.

Bilingual a plus.

PHYSICAL REQUIREMENTS

Must be able to operate a computer.

Must be able to operate a telephone

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