Provider Staffing Lead at Overland Park

Job Description

This position is responsible for the solicitation, coordination and provider assignment to meet the prescribed requests for home health services or durable medical equipment from referral sources and patients. Issues authorizations in accordance with Utilization Management Guidelines per payer. Coordinates safe and timely discharge of patients from facilities per discharge dates and payer turnaround time expectations. Gathers information using scripted clinical and non-clinical questions. Assists Supervisor/Manager with coaching, training, call monitoring, mentoring of new associates, assigning and monitoring work, and driving results. Works under moderate supervision with clinical oversight, as needed.

Abides by and demonstrates the company Mission Vision Values through both behavior and job performance on a day-to-day basis.

Responsible for timely and thoughtful communication to the referral source, physician, and patient to ensure coordination of services and equipment to meet physician prescribed starts of care and/or discharge dates. Also responsible for communication to department leadership when difficulty securing a provider jeopardizes safe and timely care for a patient. Requests clinical input, and/or communicates with Client Services when quality of care issues are in question.

Solicits providers in accordance with CareCentrix credentialing, quality, and pricing guidelines. When working outside of the CareCentrix network adheres to out-of-network qualification standards and ensures pricing is commensurate to CareCentrix client reimbursement.

Consults with associates within internal RCC functions, as well as CareCentrix manuals and reference pages, to ensure issuance of service authorization forms (SAF) to providers in accordance with payer guidelines.

Ability to take full accountability and ownership of a large case load from assignment of case ensuring patient discharges timely, or if already home that care begins per the physicians request. Requires dynamic ability to prioritize multiple times throughout the day, as well as excellence in time management.

Demonstrate critical thinking skills and utilize appropriate documentation to ensure URAC core and HUM standards are met.

Assists Supervisor/Manager with coaching, training, call monitoring and mentoring of new Intake associates. Assigns and monitors work to drive positive results.

Participates in and contributes to performance improvement activities.

Adheres to and participates in Companys mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. Adheres to Utilization Management and URAC standards.

Participates in implementing / maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.

Reviews and adheres to all Company policies and procedures and the Employee Handbook.

Participates in special projects and performs other duties as assigned.

Job Requirements

Embraces the values of accountability, consistency, engagement, empowerment, respect and outstanding service. This position requires excellent communication, customer service and problem solving skills, as well as, the ability to effectively interact with all levels of management and a highly diverse clientele. Must be able to effectively manage and prioritize tasks and thrive in a fast-paced environment. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Required Experience

Associates or bachelors degree or two years of patient case management/social work required. Case management or hospital experience preferred. Knowledge of Microsoft Office suite and comfort in a multi-system computer based environment essential. Ability to organize, manage multiple tasks simultaneously, and communicate with multiple parties while demonstrating critical thinking and problem resolution are imperative to success in this position. Has expert knowledge of department systems and processes, CareCentrix business protocols, and relevant legal and regulatory knowledge.

Country: USA, State: Kansas, City: Overland Park, Company: CareCentrix.