Enters all authorizations into the MS4/Midas daily, Expert in documentation, communication, teamwork, and customer service. Emergency Room, ICU, Med/Surg, Behavior Health and Outpatient Services), Certifies all managed care and commercial admissions requiring approval by the insurance carrier on the next business day after admission and performs concurrent phone calls as indicated by insurance carrier to ensure hospital reimbursement, Organizes individual patient care meetings with multidisciplinary team members and the patient/family to evaluate progress and to identify and resolve problems that may interfere with a positive patient outcome, Assesses discharge planning needs to ensure a safe, timely and efficient discharge, Arranges for community services (including short and long term placement) prior to discharge to meet patient’s needs with recognition and documentation of patient choice of service providers, Provides patient education and advocacy as needed, Identifies variances during the patient’s stay in order to evaluate and improve processes that effect the efficiency and quality of patient care, Demonstrates effective use of hospital and community resources within established reimbursement guidelines, Initiates physician advisor reviews on all cases not meeting established criteria for admission and/or continued stay to insure appropriate utilization of services, Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure an optimal patient outcome, Communicates denials from third party payors to the physician, and/or Chief of Service or designee and the Director to ensure a timely appeals process. Below, you'll find detailed information on skills to highlight on your resume, along with management resume examples for a variety of management jobs (including customer service, finance, human resources, operations, technical, and general management positions). Presents cases at case rounds/conferences to obtain a multidisciplinary perspective and recommendations in order to achieve optimal outcomes, Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health, Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices, Helps member actively and knowledgably participate with their provider in healthcare decision-making, Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs, This position requires the candidate to be located in Cincinnati, OH as home visits are a part of the job requirements**, Extensive knowledge of community resources/services, Complete telephone assessments and referrals; gathers demographic and clinical information to connect patient with appropriate provider and for emergency, urgent, and routine referrals, Coordinates with other Care Managers within VO as well as within other facilities/agencies to ensure that patient comprehensive treatment needs are met, Coordinates member’s service needs with community agencies, Provide education to member about Behavioral Health and/or Substance Abuse Diagnosis and medication management, Provide clinical guidance and support to assist member in achieving their goals, Prepares for and participates in all clinical rounds and clinical, Analyzes specific utilization problems. Determines if all TRICARE standardize components are indicated such as support targeted skills, goals and objectives that are measurable, time limited and appropriate for beneficiaries, Reviews ECHO referrals received through all reports, directly referred by fax, telephonic, or web based pend system. Ensure that each patient meets the clinical needs for admission, treatment, and discharge and initiates appropriate follow through with the health care team. Master’s Degree in Nurse Practitioner Program, preferred, Prior experience in one of the following areas: outreach, screening, supportive counseling, or case management, required, Working knowledge of computer applications (i.e. Demonstrates the knowledge and skills necessary to provide care needs appropriate to the age of the patients served on his or her assigned patient populations. Involves additional providers as needed to support the individualized plan of care based on identified needs of the patient and family and/or care giver. As a DSP, my daily routine consisted of visiting the company’s patients at their homes and providing care … … Demo- gra. Ability to be a self-starter, be self-innovative, be self-disciplined, Exhibit confidence in communicating working with patients, families, team, and community, Have experience working with electronic medical records (EMR), Have experience working community partners and developing relationships, Have at least 3 years experience working with patients in a medicalmbulatory healthcare setting, Location/Facility – Baylor Scott & White Hillcrest Medical Center, 2+ years of clinical nursing experience in an acute care or community setting and 1+ years of case management experience in a managed care setting is required, Long Term Acute Care Experience or Home Health Experience translates well into this position (preferred), Conduct comprehensive patient assessments to include: psychosocial needs, functional needs and patient understanding of their chronic conditions in order to identify gaps and barriers to optimal care, Act as a patient advocate by coordinating with and referring to health plan(s) utilization and disease management program(s) where appropriate, Assess clinical information to develop an individualized care or transition plan, as appropriate, to address services necessary to safely transition the patient to the community, including but not limited to, patient needs related to housing, transportation, availability of caregivers and other transition needs and supports, Develop collaborate care plans, in conjunction with physician, patient and health plan to address and achieve immediate and ongoing needs and goals, especially those patients identified as high risk, Coordinate with patient’s primary care provider, specialists, and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care, Routinely assess and monitor patient’s status, needs, and progress. Completes the Face to Face Health Functional Assessment and Service plan. 972 Idd Program Manager jobs available on Indeed.com. Contacts medical team members to discuss patient’s course of progress and needs. Information will be used for such activities as patient assessment, care planning, patient/care evaluation, case tracking and risk predictions, as well as, cost analysis, As a member of the care delivery team, works to facilitate patient compliance and ensure continuity of care per the team’s “care plan” throughout the patient’s tenure in the Program, Regularly assesses and evaluates the effectiveness and quality of services. Cannot be days-only or nights-only or weekends-only, Conducts initial psychosocial assessment of members through interviews of member, family, significant others to determine support structure, religious needs, emotional and psychological needs, needed community resources and barriers to successful transitions, Collaborates with healthcare team involved in patient’s care to enhance care plan and integration of services. … Knowledge of managed care and state specific expertise preferred, Responsible for clinical decisions related to beneficiaries seeking access to their benefits for Mental HEalth or Substance Abuse Services for all levels of care using established criteri, guidelines and policies, Builds positive professional rapport with providers and communicates effectively, Utilizes rounds and case consultations woth Clinical Supervisor, Peer Advisor for cases outside criteria or not progressing, Coordinates with providers and other Care Managers to assure that patient comprehensive treatment needs are met and that there is continuity of patient care, Maintains confidentiality, ethical and professional standards, adhering to Clinical Policy and Procedures and Benefit Plan requirements, Performs concurrent reviews with treatment team providing ABA services, Performs initial case requests for autism services, behavioral health and ABA. Reviews IEP, psych testing and other case evaluation materials, Provides information to members and providers regarding mental health and autism benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria, Interacts with the company's Medical and Associate Medical Directors and/or Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases, Leads or participates in activities as requested that help improve Care Center performance, excellence and culture. Social work case managers help make sure that individuals and families get … With the right training and a good resume, this can be a rewarding career. (3 or more years is preferred. - Choose from 15 Leading Templates. Precerts include adult and child/adolescent members from all Community Care being admitted to mental health and substance use disorder services, as well as afterhours/weekend completion of precerts for UPMC Health Plan Commercial and SNP lines of business, Consults with appropriate physician advisors as needed for case collaboration and care planning, Coordinates, reviews, and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports to address member incidents, provider deficiencies, and quality of care concerns, Demonstrates advanced level of computer operation with electronic medical record systems and Microsoft Outlook, Word, and Excel Programs, as well as advanced typing proficiency, Develops specific clinical interventions and coordinates with the assigned Community Care contract and care management team for members who do not maintain regular contact with their behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care, Identify need for and facilitate linkages for members and families between primary care and behavioral health providers and other social service or provider agencies to develop and coordinate service plans, Independently problem solves based on advanced-level knowledge of the service delivery system, clinical treatment, diversion resources, and the provider network for adult and child/adolescent members for behavioral health and SUD providers from the requested region, member services policies, members' rights and responsibilities, and the operating practices of the organization, Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services. 225 Idd Care Coordinator jobs available on Indeed.com. Works closely with Member Care services Associates for EPSDT tracking and audits, May provide direct patient care per DHS Face to Face HFA requirements, Provides direct patient care on an as needed basis. Assess short-term and long-term needs and establishes care management objectives, Manages 60+ members based on case intensity and acuity. Care Plan Worksheet And Example Goals and Steps . All qualified applicants will receive consideration for employment without regard to race, … Facilitates and ensures open communication among the health care team and the patient/family. Practices within the scope of ethical principles, Utilizes outcomes data to improve ongoing care management services, Be enthusiastic, innovative, and flexible, 3-5 years of clinical practice experience is required, Strong organizational skills are required, Minimum of 3-5 years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required, Some familiarity with the Spanish language required, Active, unrestricted RN License for State of FL required, Experience with the adult population highly preferred, Minimum of 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required, Program of All-Inclusive Care for the Elderly (PACE) is preferred, Certified Home Health Aide (CHHA) is preferred, Works with designated contacts from the customer to answer their functional questions regarding supported Ariba products, Conducts site visits (maximum of two per year) to the customer to better understand their support needs, Provides monthly customized reports to the customer of their Ariba Customer Support activity in a format and including data as agreed with the customer, which may include service request status and updates, categorization of issues raised, identification of recurrent issues and related training needs, service level tracking, etc, Ability to work effectively under pressure, Electronic Medical Record (EMR) experience; Cerner strongly preferred, One year of care management experience in a hospital setting; three years of hospital based care management experience preferred. Ensures that the sequencing and scheduling of interventions, treatment, and procedures are in accordance with the clinical pathways or the patient's treatment plan, Optimizes the efficiency of hospital systems which impact quality and/or length of stay 2.1. Assists the Center Medical Director with the management of high-risk patient populations and appropriate Case Management plans, Performs case management, but spends the majority of time performing triage functions, Ability to obtain CPR certification within 60 days of employment, LPNs must have the ability to obtain IV Certification within 90 days of employment, Five years of acute care clinical experience preferred, Ability to interact and communicate effectively with patients and all levels of personnel in a professional, courteous and effective manner using excellent customer service skills, Strong working knowledge of triage nursing principles, theories and practices/, Ability to take vital signs, perform approved clinical tasks including but not limited to: evaluate patient needs, emergency triage, administer prescribed medications, assist physician with examinations and treatments, prepare and apply dressings and perform wound care; instruct patient in health measures and self-care; change Foley catheters, and flush ports (or be willing to learn), Ability to record findings and observations, Knowledge of medical equipment and maintenance, Ability to provide on-site emergency treatment, Ability to multi- task in a high paced environment with good organizational skills, Ability to read, speak, write, and understand the English language fluently, Provides concurrent medical management as needed to ensure medical necessity and compliance with applicable medical policy and health plan benefits, Develops alternate plans and assist patients and Providers to navigate the healthcare system optimizing benefits. 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