- Department: Member Services
- Schedule: 8-hour day shift, Monday - Friday
- Facility: Automated Benefit Services, Call Center
- Location: Troy, Michigan
Benefits
Paid time off (PTO)
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Case management
Health Insurance Case Manager - Registered Nurse - Req ID: 234765
Details:
- Department: Ascension Case Management Insurance
- Schedule: Days: M-F
- Location: Remote, Austin, TX
Benefits:
- Paid time off (PTO)
- Various health insurance options & wellness plans
- Retirement benefits including employer match plans
- Long-term & short-term disability
- Employee assistance programs (EAP)
- Parental leave & adoption assistance
- Tuition reimbursement
- Ways to give back to your community
Responsibilities:
Ascension is currently seeking an experienced Case Manager - Registered Nurse (RN) to support programs of Dell Children's Health Plan (DCHP). In this position, you will coordinate the overall interdisciplinary plan of care for patients, from admission to discharge. Other responsibilities include:
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
- Provide member education
- Facilitate member access to community based services
- Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
- Direct care to participating network providers
- Perform duties independently, demonstrating advanced understanding of complex care management principles
- Participate in case management committees and work on special projects related to case management as needed
- Coordinate service request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCO
- Facilitate member linkages to MCO-based services and programs in collaboration w/ agency staff
- Assist members and/or agency staff w/ transportation to healthcare appointments
- Other duties as assigned
Requirements:
Licensure / Certification / Registration:
- Registered Nurse obtained prior to hire date or job transfer date required. Licensure required relevant to the state in which work is performed.
- Case Manager credentialed from the American Case Management Association (ACMA) preferred.
- BLS Provider preferred. American Heart Association or American Red Cross accepted.
- Case Manager credentialed from the Commission for Case Manager Certification (CCMC) preferred. Licensure required relevant to state in which work is performed
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Claims
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Configuration
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Customer service
ACA Health Plan Representative - Req ID: 226913
We are hiring multiple candidates for this role.
Job Description
Details
Benefits
Paid time off (PTO)Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your community
*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: PRN, Short-Term Option, etc.). Connect with your Talent Advisor today for additional specifics.
Responsibilities
As an ACA Health Plan Representative, you'll answer incoming calls and perform triage of inquiries.- Respond to telephone and/or Internet inquiries from customers seeking information and/or resources, following a set standard.
- Collect relevant caller data to assist with measurement, tracking and reporting activities.
- Track inquires, questions and answers and provide resolution.
- Perform additional clerical duties as assigned.
- Calculate pension benefits and payment worksheets with a high degree of accuracy.
- Verify and audit benefit calculations and payment worksheets completed by peers.
- Research pension plan provisions and pension law to ensure accurate completion of pension benefit calculations, with ability to articulate plan provisions to participants.
- Collect, review and reconcile participant data and resolve data issues.
- Independently manage workload and handle multiple tasks to ensure timely completion of work assignments.
- Knowledge of healthcare claims, Medicaid and Medicare.
Requirements
Education:- High School diploma equivalency OR 1 year of applicable cumulative job specific experience required.
Note: Required professional licensure/certification can be used in lieu of education or experience, if applicable.
Additional Requirements:
- 1 year of healthcare call center experience.
- FACET experience, preferred.
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Enrollment
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Project management
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