intake spe cialistSuperstaff

The Intake Specialist works with patients, providers, and Plan sponsors to meet the patient's health needs through communication and available resources to promote quality cost-effective outcomes via the medical management process. The Intake Specialist will have a high degree of clinical skills and will be capable of detailed assessment and planning for selected or referred patients. The Intake Specialist will collaborate with the patient, family as appropriate and necessary, physician, and other members of the healthcare team, to facilitate and coordinate healthcare services utilizing the patient-centric medical management process to set priorities, plan, organize, and implement interventions; provide utilization management services; provide patient education and support.
Responsibilities:
Utilize the P3CM process for member-specific assessment, education, planning, goal setting, facilitation, and coordination of medically necessary and appropriate health care services, moving the member toward higher levels of self-care as appropriate;
Patient Care representatives are responsible for reviewing and understanding the scope of practice of their state of licensure and practicing case management and utilization management within that scope of the license.
Document accurately and comprehensively the assessment and plan of care as outlined by the URAC Case Management Organization Standards
Document case notes and other activities accurately and comprehensively in a professional manner;
Negotiate price, level of care, intensity, and duration of services
Provide utilization management/review services for cases using evidence-based clinical practice guidelines
Interact and communicate, by telephone in a professional manner
Implement fiscal accountability, understand its impact on resources; and be able to perform financial analyses
Implement, monitor, and evaluate the patient's plan of care on an ongoing basis, moving the member toward goal accomplishment and/or higher levels of wellness;
Evaluate health care services offered and provided by members of the health care team, analyze variances according to evidence-based clinical practice guidelines, and participate in the quality improvement
Processes to enhance and improve AIMM's medical management services and member outcomes
Demonstrate sensitivity to culturally diverse situations, patients, and customers
Provide quality, cost-effective medical care management for members with catastrophic and chronic illness/injuries
Remain current with alternative resources and treatments in outpatient and alternative care settings
Support training initiatives as assigned
Participate in the Quality Management Program/Committee as requested
Responsibility for maintaining ongoing availability to and monitoring and oversight of non-clinical staff.
Will perform other duties, consistent with their education and training, as assigned
Will consistently demonstrate an ability to exceed minimum productivity and audit standards
Will demonstrate efficiency in handling calls
Will demonstrate that the content of conversations is meaningful and robust and that a relationship has been quickly and efficiently established with the patient
Will demonstrate, through work completed, a teamwork attitude in completing all necessary activities associated with the job
Requirements
Bachelor's Degree (or higher) in a health-related field
A licensed to practice as a Registered Nurse
2-3 years of clinical practice experience
Minimum of 2 years experience in one of the following areas, or a combination of 5 or more years in the following areas:
Acute Care, medical/surgical
Specialty care areas
Long-term care
Home health care
Core Competencies:
Able to:
Effectively manage multi-task functions
Employ analytical thinking;
Perform duties in an ethical manner;
Understand business management theory and practices;
Manage change;
Prioritize, analyze, and negotiate multidirectional communication for consensus;
Commit to quality medical management and healthcare service(s);
Be self-directed in a responsible manner;
Work as part of a team;
Utilize technology in a professional, proficient manner
Demonstrate excellent time management, organization, prioritization, research, analytical, negotiation, communication (verbal and written), and interpersonal skills
Effectively manage multi-task functions
Benefits
HMO with 1 free dependent upon hire
Life Insurance
Night Shift
20 PTO credits annually
Great Company Culture
Career Growth and Learnings
A laptop will be provided by the company
ONSITE WORK
23,000 - 28,000 monthly salary
SuperStaff

Angeles City, Pampanga
Permanent
Full-time