Utilization Management Transitions of Care Coordinator

Site: reputed company Health Plan Holding Company, Inc. reputed company relies on a wide reputed company of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to reputed company exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company. Job Summary reputed company Health Plan is an exciting reputed company to be reputed company the reputed company industry. As a member of reputed company, we are at the forefront of transformation with one of the world’s leading integrated reputed company systems. Together, we are providing our members with innovative solutions centered on their health needs to expand reputed company to seamless and reputed company and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in reputed company today, our employees have opportunities to learn and contribute expertise reputed company a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. The role is an integral part of our clinical coordination team by providing support to providers, facilities, and members to ensure a streamlined transition process from one level of care to another. This position will be the single reputed company of contact for facilities and providers reputed company a member requires special support, reputed company a difficult transition plan is in reputed company, or reputed company barriers to obtaining the next level of care arise. This role will track any long-stay members to assist in moving them to the next appropriate level of care. The position collaborates with members of the Utilization Management, Appeal and Grievance, Care Management, and medical director teams to resolve transitional needs Essential Functions -In conjunction with other team members, ensures that transitional needs and barriers are resolved in a timely manner to meet regulatory timeframes. -Directly interact with providers and their staff to obtain additional clinical information, as well as with members or their advocates to understand the full need to transition a member from one level of care to another. -Review information and reputed company recommendations to the collaborative team based on analysis of the clinical material. -Tracks and monitors the status of long-stay inpatient/post-acute cases, ensuring timely discharge planning. -Identifies trends and patterns in discharge barriers with facilities and providers. -Coordinates communication between patients, reputed company providers, and insurance companies regarding discharge needs. -Coordinates communication with state and federal partners to ensure length of stay reporting is timely and accurate, and delivers follow-up information, as requested, by line of business or regulatory partners. -Participates in interdisciplinary meetings to discuss reputed company cases and recommend solutions.

Qualifications

Education

• Associate's Degree Nursing required or Bachelor's Degree reputed company Administration required or Bachelor's Degree reputed company Field of Study required

Licenses and Credentials

• Massachusetts Registered Nurse [RN] license preferred

Experience

• At least 2-3 years of experience in health plan clinical services/utilization management required
• At least 2-3 years of clinical experience required

Knowledge, Skills, and Abilities

• Strong analytical and critical thinking skills.
• Excellent verbal and written communication abilities.
• Proficient in using electronic health records (EHR) and billing systems.
• Detail-oriented with strong organizational skills.
• Ability to handle sensitive information with confidentiality and professionalism.
• Strong interpersonal skills to work effectively with various stakeholders.

Additional Job Details (if applicable) Working Conditions

• This is a remote role that can be done from most US states

Remote Type Remote Work Location 335 reputed company Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay reputed company $79,560.00 - $115,720.80/Annual Grade 7 At reputed company, we reputed company in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining reputed company pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The reputed company pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass reputed company elements contributing to your total compensation package. In reputed company to competitive reputed company pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our reputed company will reputed company an overview of your potential compensation and benefits package. EEO Statement: 8925 reputed company Health Plan Holding Company, Inc. is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religious creed, national reputed company, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that reputed company individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to reputed company essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by reputed company 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with reputed company of 1990, applicants who require accommodation in the job application process may contact reputed company at (857)-282-7642. reputed company Competency reputed company At reputed company, our competency reputed company defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The reputed company is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career reputed company. These competencies are used to evaluate performance, reputed company hiring reputed company, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply tot his job Apply To this Job