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Case Mangement Facilitator at Independent Health Assoc., Inc.

Posted in General Business 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Williamsville, New York





Job Description:

Job Description

Overview

The Case Management Facilitator (CMF) acts as a central point of contact for medical management program referrals and coordinates the delivery of clinical summary documentation for case or disease managers, stop loss and high dollar reporting purposes. The Case Management Facilitator is responsible to coordinate referrals to RN based off of members identified through high dollar claims reports and refer members to a Registered Nurse to determine appropriateness for medical management programs. The CMF generates and sends updated stop loss notifications that have been prepared by the Registered Nurse....  The CMF acts as a primary point of contact and facilitates submission of the Case or Disease Manager(s) program documentation and distributing the reports to the Stop loss Administrator regarding required information to meet client stop loss and/or reinsurance carriers previously defined expectations. The CMF will also have responsibility to coordinate the delivery of updated treatment plans and/or test results, for potential reoccurrence or exacerbation of condition to a Registered Nurse for assessment and evaluation for Case or disease Management program enrollment.... 

Qualifications


  • Active, unrestricted, and Licensed Practical Nurse (LPN) in New York State required; Licensed Registered Nurse (RN) preferred.

  • Four (4) years of experience as a qualified health care professional in a med/surg or ambulatory care setting; clinical, behavioral health setting or social work setting required.

  • Ability to interact effectively with a wide variety of individuals, both internal and external to the company.

  • Ability to manage multiple priorities with attention to detail and follow-up.

  • Proficient PC and Windows skills required, including MS Office.

  • Self ......" Motivated with excellent problem-solving abilities, coupled with solid time management skills.

  • Excellent written, verbal and interpersonal communication skills.

  • Demonstrated transferable knowledge, skill and ability to complete job duties independently and proficiently and within required timeframes.

  • Proven examples of displaying the Nova values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant.........s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP information