Prepare examination rooms and sterilize medical equipment & instruments Room patients, obtain health history and check vital signs Document patient care using electronic medical record software Administer medications and perform injections/immunizations Assist providers with minor, in office procedures and perform point of care testing Schedule appointments, complete prio

Mange the intake of members or the admission/discharge information post notification Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles Provide appropriat

Works with the PCP and clinic staff to identify patients with high risk diagnoses such as CHF, IHD, COPD/asthma and diabetes and ensures clinical guidelines are being followed Contacts and performs initial interviews with patients who are in need of health coaching programs Conducts Chronic Care Model visits and reviews the patient's informal and formal support systems, f

Accurately schedules and coordinates patient appointments for assigned clinics. The ability to work in a high call volume environment while meeting productivity and quality standards. Analyzing provider schedules to ensure maximum capacity is met. Obtains eligibility and benefit information in a timely manner assigning FSC (Financial Class) entering benefits and all other

Prepare examination rooms and sterilize medical equipment & instruments Room patients, obtain health history and check vital signs Document patient care using electronic medical record software Administer medications and perform injections/immunizations Assist providers with minor, in office procedures and perform point of care testing Schedule appointments, complete prio

improving the quality, cost and experience of health care. Here, we focus on delivering the best patient care, rather than volume. Through innovation and superior care management, we support patients and your well being as a team member. Join a team at the forefront of value based care and discover the meaning behind Caring. Connecting. Growing together. Utilizes independ

Conduct comprehensive assessments Manage members through an acute medical situation or an exacerbation of a chronic condition, including testing, diagnostics, interventions Manage members during a short term sub acute rehabilitation episode Ensure accurate and complete documentation, including ICD 10 conditions Communicate and collaborate with the interdisciplinary care t

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Responsible for the tracking, coordination and communication of patient referrals in work queue. Collaborate with Practices to ensure complete and accurate patient registration, including demographics and current insurance. Assembles information concerning patient's clinical background in EPIC to help with referral. Contacts insurance companies to ensure verification of b

Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing Understands and complies with long term care policies and procedures, including those that regulate nursing facilities and assisted living communities Establishes and maintains effective relationships with members and their legal representatives, faci

Documents all patient interactions in a concise manner that is compliant with documentation requirements for Model of Care, NCQA and Center for Medicare and Medicaid Services (CMS) regulations. Receives and responds to incoming Care Coordination inquiries from all communication venues e.g. phone queue, TruCare, portal, claim queue, department e mail box or Rightfax. Coord

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Manage the evaluation of payer proposals related to Fee For Service (FFS), capitation arrangements and value based contracts Partner with the payer contracting team to manage the modeling and negotiation process, evaluate proposals, and provide guidance to senior leadership on the financial impact and viability of the contract Work closely with the Finance and Actuarial t

Primarily answering prior authorization with inbound calls (up to 50 to 70 calls per day) from providers/members as well as research and resolve formulary and benefit issues using the appropriate reference material Process authorizations through various computer systems and use of job aid/policies/procedures ensuring the accuracy of all data and updating as necessary Have

Primarily answering prior authorization with inbound calls (up to 50 to 70 calls per day) from providers/members as well as research and resolve formulary and benefit issues using the appropriate reference material Process authorizations through various computer systems and use of job aid/policies/procedures ensuring the accuracy of all data and updating as necessary Have