Richmond, Virginia
Care Coordinator - Richmond Job Opening in Richmond, Virginia - The Care Coordinator will work with Care Center of Excellence, Physician Management Resources (PMR), market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management in ChenMed Medical Centers.
Primary Duties and Responsibilities
· Daily review of approved and pended outpatient requests for PMR clients and ChenMed Markets.
· Provide actionable insights to PMR/ChenMed team from review of outpatient census as related to referral patterns, specialist?s utilization and cost data.
o Provide insights to the PMR team and Network Director and work with them to take action.
· Facilitate a daily process to help redirect poorly supported requests by:
o Providing feedback to Humana, Careplus, Wellcare and Coventry and working through daily authorization requests when information is missing.
o Create process for managing requests when patients need to see the primary care provider by coordinating with primary care provider and Market leaders.
o Enable a member of PMR network or clinical team to reach out to authorization requester when deemed necessary.
Other responsibilities may include:
· Drive the current utilization management model to a sustainable and reproducible one dependent on market needs.
· Travel as needed to PMR & ChenMed markets for training and support.
· Other duties as assigned and modified at manager?s discretion.
KNOWLEDGE, SKILLS AND ABILITIES:
Excellent analytical skills in order to solve the complex and logistical problems.
Strong communication and interpersonal skills, both written and verbal, as well as delivery skills for presentations and training.
Excellent organizational skills with ability to effectively manage multiple tasks and responsibilities.
Ability to deliver efficient, high quality results within tight deadlines.
Works well independently and within a team.
Excellent influencing and negotiation skills.
Ability to explain complicated financial terms and utilization data to physicians/staff.
Ability to understand, interpret and communicate all types of provider, regulatory contracts and utilization management data.
Fluent in English.
Education / SPECIALIZED KNOWLEDGE :
· Bachelor's degree. Preferred
· 3+ years Utilization Management and/or Provider Relations or Healthcare Analyst experience or similar background.
· 3+ years? experience in Medicare HMO.
· Advanced MS Word and Excel.
· The ability to establish credibility quickly and the willingness to take a strong approach to leadership.
· An understanding of the communities that ChenMed and PMR serves, including the complexities of Medicare programs to patients in the current healthcare marketplace.
Job Type: Full-time
Job Location:
Richmond, VA
Required education:
Bachelor's
Required experience:
Medicare HMO: 3 years
years Utilization Management and/or Provider Relations or Healthcare Analyst: 2 years
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