Address
Form of workPosition Title: Program Coordinator 1 (Remote Work) Locations: REMOTE - Only CST Anticipated Start Date: 5/2Expected Duration: 3 monthsJob Type: Contract to Hire (C2H)Shift: 8:00-5:00 M-F, 2 paid 15 min breaks per day, 30 min unpaid lunchPay Rate:$20.50/hr on W2.Note : Need Expertise with HEDIS, QARR, HRA And High-Volume Calling experience
Job Description:Managers Note: In the event that OT is required, the hiring manager will inform the workers ahead of time. Towards the end of the year there may be an opportunity for the worker to participate in OT during possibly (late October - November, December) TBD
Position Purpose: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
Daily Responsibilities:
Customer service
Calling members via phone
Calling the member and providing service
Outbound calling
Purpose of team is to close care gaps, and ensure they are being addresses.
HEDIS -Health Effectiveness Data and Information Sets
QARR - Quality Assurance Reporting Requirements
PSO - Preventative Service Outreach (Majority)
HRA - Health Risk Assessment (Filler / temporary)
Required Skills/Experience:
HEDIS / QARR
Exceptional work ethic
Needs to demonstrate leadership capabilities. This person is going to need to be able to problem solve.
Strong organizational skills
Exceptional phone behaviour
Healthcare background (doctors office, hospital setting, 2+ years)
Medical Terminology
Education Requirement: HSD
Software Skills Required: Microsoft Office, must have stable internet connection, must be connected to secure Wi-Fi (home) not Starbucks, hotels, etc.
Interview Process: [i.e.: Panel, Phone, Web Conference] Web Conference **VIDEO READY**
Education/Experience: High school diploma or equivalent. 2-3 years managed care setting, medical office or facility setting with demonstration of medical administration duties. Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.
For Illinois Youth Care contract: Required Education/Experience - Bachelors Degree in nursing, social sciences, social work, or a related field. 1 year supervised clinical experience in a human services field.
For Oregon plan only: A valid driver's license is required.
* Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility.
* Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
* Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the members attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
* Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material.
* Data enter assessments and authorizations into the system.
Interested candidates please send resume in Word format Please reference job code 221559 when responding to this ad.
