DaVita Assistant Care Management- Roma in ALBUQUERQUE, New Mexico

Assistant Care Management- Roma

Description

Assistant Care Management- Roma

Overview of Position:

  • Under general supervision, supports the administrative requirements of the Care Management department. Responsibilities include providing verbal confirmations and written documentation of determinations regarding benefit eligibility, authorizations for inpatient admissions and outpatient precertification and/or prior authorization requests. Refers cases requiring clinical review to appropriate Care Manager or UM nurse reviewer. Responds to telephone and written inquiries from patients, providers and in-house departments regarding Care Management, as well as performing outreach calls to patients regarding Case Management and Disease Management programs. This is performed under the direct supervision of the Medical Director, Care Management.

Essential Functions:

  • Provides direct customer service and administrative support to the Care Management Department. This includes but is not limited to providing electronic eligibility verification, updating patient demographics, ensuring required referrals and pre-certifications are forwarded to correct Providers in a timely manner.

  • Handles customer/patient inquires that are forwarded to Care Management, referring to internal department resources for appropriate for resolution.

  • Responsible for obtaining “expert” level knowledge of the benefit plans and the contracts with the various insurance plans, Medicare and Medicaid, regarding prior authorization processes, precertification requirements and other functions related to Care Management of patient populations services by DaVita Medical Group. This includes staying abreast of insurance plans in the process of being added, deleted or changed.

  • Responsible for compiling Care Management data and coordinating Care Management data reports as required by DaVita Medical Group’s contracted partners and regulatory agencies.

  • Responsible for contacting patients to educate and/or provide communication and follow-up on the Case Management and Disease Management programs relevant to our patients conditions.

  • Adheres to policies, procedures and regulations to ensure patient safety and regulations. May attend departmental meetings and provide constructive recommendations for areas improvement.

  • Cross trains in Clinics as needed to maintain up to date knowledge of Clinic front office, back medical office and Electronic Health Record (EHR) processes to ensure appropriate support of the Care Management functions.

  • Provides additional support and project work within the various Care Management areas of accountability as needed.

Qualifications

Education:

  • Required - High School Diploma or GED equivalent.

  • Preferred - Completion of a Medical Assistant, Nurse Tech or Certified Nursing Assistant program. Certification from the American Association of Medical Assistants or the American Medical Technologies.

Experience:

  • Required - Three (3) years of related experience in Clinical setting or health plan, demonstrating intermediate skills in Microsoft Excel, and well as experience with electronic medical record systems.

Required licensure:

  • Preferred - Current BLS Certification, CMA or RMA

Knowledge, Skills, Abilities:

  • Excellent Customer Service skills, demonstrated through written and interpersonal communications. Ability to type and enter efficiently and accurately at 25-30 WPM. Skilled in a variety of MS Office software applications. Knowledge of medical terminology, benefit plans and medical office systems. Ability to work independently and willingness to learn. Ability to multi-task and work under pressure. Attention to detail. Windows navigation skills.

DaVita Medical Group is one of the nation’s leading independent medical groups and is a national medical group with operations in New Mexico, Nevada, Colorado, Florida, California and Washington. It is an exciting time to join DaVita Medical Group NM as we blaze new trails in coordinated care, setting the new standard in New Mexico for compassionate, cost-effective, high quality healthcare.

If you’re looking to make a difference with a large, financially stable, well-recognized medical group, DaVita Medical Group may be the employer for you.

DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.

DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.

Required - High School Diploma or GED equivalent.Preferred - Completion of a Medical Assistant, Nurse Tech or Certified Nursing Assistant program. Certification from the American Association of Medical Assistants or the American Medical Technologies.Experience:Required - Three (3) years of related experience in Clinical setting or health plan, demonstrating intermediate skills in Microsoft Excel, and well as experience with electronic medical record systems.Required licensure:Preferred - Current BLS Certification, CMA or RMAKnowledge, Skills, Abilities:Excellent Customer Service skills, demonstrated through written and interpersonal communications. Ability to type and enter efficiently and accurately at 25-30 WPM. Skilled in a variety of MS Office software applications. Knowledge of medical terminology, benefit plans and medical office systems. Ability to work independently and willingness to learn. Ability to multi-task and work under pressure. Attention to detail. Windows navigation skills.DaVita Medical Group is one of the nation’s leading independent medical groups and is a national medical group with operations in New Mexico, Nevada, Colorado, Florida, California and Washington. It is an exciting time to join DaVita Medical Group NM as we blaze new trails in coordinated care, setting the new standard in New Mexico for compassionate, cost-effective, high quality healthcare.If you’re looking to make a difference with a large, financially stable, well-recognized medical group, DaVita Medical Group may be the employer for you.DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.

Primary Location NM-ALBUQUERQUE - 87102

Req ID: 327752