Care Management Specialist

Fairview Health Services Princeton , MN 55371

Posted 7 months ago

Overview

The Care Management Specialist is responsible for establishing and maintaining relationships with providers, patients, families and vendors of Fairview Partners, as well as serving as the liaison between Fairview Partners and the health plans for all community enrolled members. The Care Management Specialist directly supports Fairview Partners Care Coordinators.

Responsibilities/Job Description

Serve as a liaison to patients, vendors, providers, and health plan representatives to resolve issues related to billing and health plan referral verification:

  • Understands the guidelines and processes within each health plan surrounding claims payment for patient referrals.

  • Assists case managers or providers with utilization, authorization, and claims payment as appropriate and requested.

  • Coordinates and facilitates services as directed by the Care Coordinator.

Performs, understands and can explain functions related to the referral process of patients:

  • Approves/Directs patient referrals to appropriate setting.

  • Understands benefit structure of each contracted health plan.

  • Communicates directly with vendors, clinics and payers or as needed to patients.

Responsible for oversight of monthly member reporting:

  • Reviews health plan member reports for accuracy which ties to monthly capitation payments from health plans.

  • Works with the health plans and care coordinators to correct discrepancies and appropriately assigns members to correct care system.

  • Utilizes Excel and Access database to report new member information to providers and internal entities of Fairview.

Coordination of Member Care:

  • Assists the Care Coordinators in coordinating and ordering services for community members. This includes working with various home care agencies and community agencies to assure the appropriate services have been scheduled.

  • Researches community resources for Fairview Partners members and develops relationships with new vendors in order to utilize their services on an on-going basis.

  • Documents member information using EPIC and the Department of Human Services reporting system.

  • Monitors and processes changes to member's health plan status, agency updates, and other internal tracking spreadsheets.

  • Assists members in transportation, appointment, and DME & supply requests.

Organization Expectations, as applicable:

Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served

  • Partners with patient care giver in care/decision making.

  • Communicates in a respective manner.

  • Ensures a safe, secure environment.

  • Individualizes plan of care to meet patient needs.

  • Modifies clinical interventions based on population served.

  • Provides patient education based on as assessment of learning needs of patient/care giver.

Fulfills all organizational requirements

  • Completes all required learning relevant to the role

  • Complies with all relevant laws, regulation and policies

Performs other duties as assigned.

Qualifications

Required Education

  • Two year degree in a healthcare-related field, or minimum equivalent work experience of four years in a health care setting.

Experience

  • Two to four years of recent experience in a health care setting.

  • Two to three years of recent experience with Microsoft Word, Excel and Access.

Preferred Experience

  • Four years of experience in a health care setting.

  • Three years of experience with EPIC, Microsoft Word, Excel and Access.

  • Previous experience with referrals processing in medical office.

Additional Requirements (must be obtained or completed within a period of time):

  • Knowledge of third party payers, billing procedures and insurance.

  • Ability to work independently and exercise independent judgment.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Foodservice Specialist

Circle K Stores, Inc.

Posted 4 days ago

VIEW JOBS 10/10/2019 12:00:00 AM 2020-01-08T00:00 Job Description We want you to join our team as a Customer Service/Foodservice Specialist. This is Monday-Friday (1st shift). This is no ordinary job and you are not an ordinary person. If you have the desire to learn new skills, work in a fast-paced, fun environment and interact with a wide variety of people - look no further. What you'll be doing: Customers have many choices when it comes to food. We compete with numerous convenience stores and other quick service restaurants. One way to differentiate ourselves is by providing a superior customer experience for our customers. The Foodservice Specialist's main responsibility is to do just that by greeting our customers and providing enhanced customer care in the foodservice areas of our stores. This position is also responsible for ensuring our food and coffee products are well stocked, faced and that the foodservice area is neat, clean and inviting for our customers. You will work with a fun, energetic team that knows how to have fun and accomplish their daily tasks at the same time. You're good at: * Communication and friendly conversation * Interaction with people * Encourage customers to try our food and share food product knowledge with them * Keeping the foodservice area well stocked and clean * Performing at a quick pace while having fun * Working as part of a team to accomplish daily goals * Coming up with great ideas to solve problems * Thinking quickly and offering suggestions * Safety and security Extra awesome if you have: * Retail experience * High School Diploma or equivalent * Motivation to advance your career! working on your college degree or planning on it? Ask about our tuition reimbursement program. Holiday Stationstores provides an excellent training program to help you get started. Make a change. Great careers start here! What's in it for you? Full Time Benefits: * Competitive wages reflecting your experience * Medical, Vision, Dental, & Life Insurance/Short & Long Term Disability * Paid Vacations/Sick leave * 401K with a competitive company match * Performance and Incentive bonuses * Weekly Pay * Flexible Schedule * Service Award Program * Gasoline and Merchandise discount * Uniform allowance * Tuition Reimbursement * Flexible Spending/Health Savings Account s Part Time Benefits: * 401K with a competitive company match * Vacation * Performance and Incentive bonuses * Weekly Pay * Flexible Schedule * Service Award Program * Gasoline and Merchandise discount * Uniform allowance * Tuition Reimbursement High school diploma or equivalent * Willingness to learn and have fun! Don't have time to apply? Join our Talent Network (Click Here) By joining our Talent Network you'll be notified when positions open that fit your interests and you can also upload a resume for our recruiters to review. Circle K Stores, Inc. Princeton MN

Care Management Specialist

Fairview Health Services