Showing 789 Healthcare Administration jobs in Des Moines

Remote Healthcare Administration Apprentice

23451 Virginia Beach / Remote Placements24

Posted 16 days ago

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Job Description

intern
About the Role

Our client, a leading provider of telehealth services, is seeking an enthusiastic Healthcare Administration Apprentice to join their fully remote operational team. This is an excellent opportunity for someone passionate about healthcare and interested in the administrative side of patient care to gain valuable experience. You will work closely with our administrative staff, supporting patient scheduling, medical records management, insurance verification, and general office duties. This role is designed for individuals who are highly organized, detail-oriented, and possess strong communication skills. As a remote position, you'll have the flexibility to work from your home office while being an integral part of a supportive, patient-focused team dedicated to improving healthcare accessibility through technology. This apprenticeship offers comprehensive training and exposure to the healthcare administration field.

Key Responsibilities
  • Assist with patient scheduling and appointment coordination using our telehealth platform.
  • Manage and update electronic health records (EHR) with accuracy and confidentiality.
  • Support the verification of patient insurance information and billing details.
  • Handle incoming patient inquiries via phone and email, providing excellent customer service.
  • Assist in the preparation and organization of medical documentation.
  • Maintain office supplies and manage general administrative tasks remotely.
  • Learn and adhere to HIPAA regulations and other healthcare compliance standards.
  • Collaborate with clinical staff and other administrative team members to ensure smooth operations.
  • Contribute to process improvement initiatives within the administrative department.
Requirements
  • High school diploma or equivalent required; some college coursework in healthcare, business, or a related field is preferred.
  • Excellent organizational and time-management skills, essential for remote work.
  • Strong verbal and written communication abilities.
  • Proficiency in Microsoft Office Suite (Word, Excel, Outlook) or Google Workspace.
  • Familiarity with medical terminology and basic understanding of healthcare systems is a plus.
  • Ability to maintain confidentiality and handle sensitive information with discretion.
  • Self-motivated and able to work independently in a remote setting.
  • Reliable internet connection and a suitable home office environment.
  • A compassionate and patient-centered approach.
Benefits
  • Comprehensive training in healthcare administration and telehealth operations.
  • Hands-on experience with electronic health records and patient management systems.
  • Exposure to regulatory compliance in the healthcare industry (e.g., HIPAA).
  • Mentorship from experienced healthcare administrators.
  • Opportunity to contribute to improving patient access to care.
  • The flexibility and convenience of a fully remote work arrangement.
  • A collaborative and mission-driven virtual team environment.
  • Potential for future growth within the organization.
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Remote Administrative Coordinator - Healthcare Operations

73101 Oklahoma City / Remote Placements24

Posted 16 days ago

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Job Description

full-time
About the Role

Our client is seeking a highly organized and empathetic Remote Administrative Coordinator to support their Healthcare Operations team. This position, operating entirely remotely from Oklahoma City, Oklahoma , is vital for ensuring the efficient and smooth delivery of healthcare services. The ideal candidate will possess excellent communication skills, a strong ability to manage multiple tasks, and a deep understanding of the importance of discretion in a healthcare setting. This is a fantastic opportunity to contribute to the healthcare sector while enjoying the flexibility of a fully remote role.

Key Responsibilities
  • Provide comprehensive administrative support to the healthcare operations team remotely.
  • Manage calendars, schedule patient appointments, and coordinate virtual consultations and meetings.
  • Handle incoming patient inquiries via phone and secure messaging platforms, providing accurate information and directing them appropriately.
  • Prepare, organize, and maintain patient records and administrative documents with a high degree of accuracy and confidentiality.
  • Assist in the processing of patient admissions, transfers, and discharge procedures.
  • Coordinate with healthcare providers, laboratories, and insurance companies to facilitate patient care.
  • Manage inventory of medical supplies and administrative equipment for remote operations.
  • Generate reports on operational metrics, patient flow, and administrative efficiency.
  • Ensure compliance with all healthcare regulations, including HIPAA, in all administrative tasks.
  • Support the onboarding of new remote staff and assist with the training on operational procedures.
Requirements
  • Proven experience in an administrative role, preferably within the healthcare industry or a related field.
  • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and familiarity with electronic health record (EHR) systems.
  • Excellent organizational and time management skills, with the ability to prioritize tasks effectively in a remote setting.
  • Strong written and verbal communication skills, with a compassionate and professional demeanor.
  • Understanding of medical terminology and healthcare administrative processes is essential.
  • Ability to maintain strict confidentiality and adhere to HIPAA regulations.
  • Self-motivated and disciplined, with the ability to work independently and manage time effectively.
  • High school diploma or equivalent required; Associate's degree in healthcare administration or a related field is a plus.
  • Experience with virtual meeting platforms and digital document management systems.
  • Reliable internet connection and a dedicated home office space are mandatory.
Benefits

Our client offers a competitive salary of 53000 per annum for this remote position. Employees are eligible for a comprehensive benefits package, including health, dental, and vision insurance. Paid time off is provided, allowing for a healthy work-life balance. This role offers the flexibility to work from anywhere while making a significant impact in healthcare operations. Join our client's dedicated team and advance your career in healthcare administration from the comfort of your home.

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HYBRID\REMOTE | Holter Tech Scanner | Iowa Heart

50265 West Des Moines Trinity Health

Posted 8 days ago

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Job Description

**Employment Type:**
Full time
**Shift:**
Day Shift
**Description:**
Must Live in the State of IOWA and have Holter Tech Experience
ESSENTIAL KEY JOB RESPONSIBILITIES
+ Maintains proficiency with all monitor equipment and procedures performed at MercyOne Iowa Heart Center as needed.
+ Screens patient's medical record for appropriate diagnosis and orders for procedures. Instructs and educates patients regarding the ordered test and prepares the patient for the procedure
+ Performs Holter Monitor testing according to established protocols
+ Performs Holter Monitor scanning according to established procedures, provides heart rhythm analysis of electrocardiograms recorded on monitor.
+ Makes general interpretation of arrhythmias; identifies adverse arrhythmias and informs nurse or physician
+ Documents symptoms, records monitor strips, & routes reports to the appropriate doctor for interpretation Transports, ambulates, and transfers patients as needed Accurately and completely documents in EHR and billing system in a timely manner
+ Responsible for maintaining strict confidentiality of patient information Acts as liaison between staff and monitor services
+ Maintains equipment in designated testing areas
+ Maintains a clean, well-organized work environment Stocks/orders supplies appropriately and coordinates monitor repairs and replacements Page 1 of 5
+ MercyOne Iowa Heart Center Holter Scanner Demonstrates customer service/interpersonal skills Takes personal responsibility for work, actions, and attitudes
+ Respects patients, peers, clients, students, physicians, service representatives, and other hospital staff Demonstrates positive and effective communication skills
+ Cooperates with peers and leaders to build and maintain an effective healthcare team Acts as a resource and helps to orient and develop new staff
+ Participates in QA activities as directed by technical and medical director Adheres to all Joint Commission, Iowa Department of Public Health, and the Intersocietal Accreditation Commission guidelines Completes department competencies in the required timeframes
+ Attends required meetings and participates on committees as requested
+ Participates in professional development activities and maintains professional affiliations Operates required vehicle(s) in a safe manner to perform required duties of the position Travels to other MercyOne Iowa Heart Center offices or MercyOne campuses as needed Performs other work related duties as required
+ **MINIMUM QUALIFICATIONS**
+ Required Education and Experience EKG/Arrhythmia training/telemetry monitoring experience preferred but will train on the job.
+ Medical terminology preferred Takes Cardiovascular Credentialing International (CCI) -Certified Rhythm Analysis Technician(CRAT) Exam within 18 months of hire Required Licensure and Certifications Proof of completion of Mandatory Reporter abuse training specific to the population served within three (3) months of hire.
+ Basic Life Support (BLS) for the Healthcare Provider certified or obtained by the end of the orientation period (approximately six (6) weeks).
+ Valid Iowa Driver's/Chauffeur's License required, must meet Mercy's Motor Vehicle Safety Standards, must be at least 18 years of age and be eligible to drive per Iowa state law.
+ Required Minimum Knowledge, Skills, Abilities and Training Basic computer skills required
**Our Commitment**
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
EOE including disability/veteran
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Health Plan Provider Relations Manager (Remote in Iowa)

50381 Des Moines Molina Healthcare

Posted 13 days ago

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Job Description

JOB DESCRIPTION Job Summary
Provides subject matter expertise and leadership for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures.
Please update your resume with any relevant Behavioral Health or value-based experience. Those qualifiers are important.
**Essential Job Duties**
- Successfully engages the plan's highest priority, high-volume and strategic complex provider community providers (including value-based payment (VBP) and other alternative payment method (APM) contracts to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
- Serves as the primary point of contact between Molina health plan and the for non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers.
- Collaborates directly with the plan's external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.
- Resolves complex provider issues that may cross departmental lines including contracting, finance, quality, operations, and may involve senior leadership.
- Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.
- Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship.
- Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.
- Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding).
- Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs).
- Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.).
- Oversees and demonstrates accountability for provider satisfaction survey results.
- Develops and deploys strategic network planning tools to drive provider relations and contracting strategy across the enterprise.
- Facilitates strategic planning and documentation of network management standards and processes (effectiveness is tied to financial and quality indicators).
- Works collaboratively with functional business unit stakeholders to lead and/or support various provider services functions with an emphasis on developing and implementing standards and best practice sharing across the organization.
- Navigates the matrix team environment including: new markets provider/contract support services, resolution support, and national contract management support services.
- Serves as a subject matter expert for the provider relations function.
- Provides training, mentoring, and support to new and existing provider relations team members.
- Role requires 20%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area).
**Required Qualifications**
- At least 6 years of provider services experience, including experience supporting individual/group providers, hospitals, integrated delivery systems, and ancillary providers with Medicaid, Medicare, and or Marketplace products, or equivalent combination of relevant education and experience.
- Strong understanding of the health care delivery system, including government-sponsored health plans.
- Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc.
- Previous experience with community agencies and providers.
- Strong organizational skills and attention to detail.
- Ability to manage multiple tasks and deadlines effectively.
- Experience with preparing and presenting formal presentations.
- Strong interpersonal skills, including ability to interface with providers and medical office staff.
- Ability to work in a cross-functional highly matrixed organization.
- Strong verbal and written communication skills.
- Microsoft Office suite and applicable software programs proficiency.
**Preferred Qualifications**
- Management/leadership experience.
- Contract negotiation experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $57,394 - $98,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Remote Medical Assistant

32806 Orlando TEKsystems

Posted 4 days ago

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Job Description

Position Summary
We are seeking a detail-oriented and customer-focused Medical Assistant to support client and provider communications within a fast-paced healthcare/insurance environment. This role is responsible for managing inquiries, tracking case progress, and ensuring accurate documentation while delivering a high level of service and maintaining compliance with regulatory standards.
Key Responsibilities
+ Serve as the primary point of contact for client, provider, and representative inquiries, ensuring timely and professional responses
+ Manage report status inquiries, general requests, and client concerns with a strong focus on customer service
+ Accurately enter, update, and retrieve information within internal systems and databases
+ Collaborate with Quality Assurance teams to monitor workflow and track pending report statuses
+ Coordinate with providers to assign cases and maintain updated records
+ Verify and maintain accurate client data, including documentation of client-specific guidelines and requirements
+ File, archive, and track open and closed cases in accordance with company standards
+ Assist in resolving customer complaints and escalate issues to management when needed
+ Perform general administrative duties including data entry, filing, email correspondence, and proofreading
+ Route calls and inquiries to appropriate departments as necessary
+ Ensure compliance with HIPAA, company policies, and all state and federal regulations
Required Qualifications
+ Certified Medical Assistant (CMA) - required 3+ years of MA experience
+ Previous experience with insurance verifications/prior authorizations
+ Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and general computer applications
+ Strong typing skills (minimum 40 WPM)
+ Excellent verbal and written communication skills
+ Ability to work independently, prioritize tasks, and manage time effectively
+ High level of accuracy, attention to detail, and accountability
Preferred Experience
+ Experience in healthcare, insurance, or workers' compensation environments
+ Familiarity with case management or database systems
+ Experience handling client or provider communications
Key Skills & Competencies
+ Strong data entry and organizational skills
+ Customer service orientation with problem-solving abilities
+ Ability to maintain confidentiality and adhere to HIPAA standards
+ Adaptability in a fast-paced, high-volume environment
+ Ability to manage multiple priorities and work under pressure
+ Team-oriented mindset with a positive and collaborative approach
Why Apply
+ Gain experience in a fast-paced healthcare/insurance environment
+ Work collaboratively with cross-functional teams including QA and providers
+ Opportunity to build strong operational and client service skills
Job Type & Location
This is a Contract to Hire position based out of Orlando, FL.
Pay and Benefits
The pay range for this position is $18.50 - $18.50/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Jul 30, 2026.
About TEKsystems
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
About TEKsystems and TEKsystems Global Services
We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.
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Remote Outpatient Medical Coder

44131 Independence Amergis

Posted 7 days ago

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Job Description

The Outpatient (OP) Medical Coder is responsible for assigning ICD-10-CM diagnosis codes as appropriate and abstracts pertinent information from patient records.
**Minimum Requirements:**
+ Must hold at least one of the following certifications: RHIA, RHIT, CCS, CCS-P, CPC, CPC-H
+ (COC) for a minimum of 2 years and have a minimum of 2 years relevant coding experience
+ Must be at least 18 years of age
**Benefits**
At Amergis, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
+ Competitive pay & weekly paychecks
+ Health, dental, vision, and life insurance
+ 401(k) savings plan
+ Awards and recognition programs
*Benefit eligibility is dependent on employment status.
**About Amergis**
Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions.
Amergis is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
**Job Category:** Revenue Cycle
**Job Function:** Revenue Cycle | Outpatient Medical Coder | Outpatient Medical Coder
**Job Type:** Contract - Full Time
**Setting:** Healthcare Facilities
**Position Type:** Healthcare
**Office Number:** 0774
**Contract Duration:** 52
**Pay Rate:** $1260 / Week
**Date Posted:** T15:26:52
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Remote Inpatient Coder

44131 Independence Amergis

Posted 7 days ago

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Job Description

The Inpatient Medical Coder is responsible for assigning ICD-10 and/or CPT/HCPCS codes as appropriate and abstracts pertinent information from patient records.
**Minimum Requirements:**
+ Must hold at least one of the following certifications: RHIA, RHIT, CCS, CCS-P, CPC, CPC-H (COC) for a minimum of 2 years and have a minimum of 2 years relevant coding experience
+ Must be at least 18 years of age
**Benefits**
At Amergis, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
+ Competitive pay & weekly paychecks
+ Health, dental, vision, and life insurance
+ 401(k) savings plan
+ Awards and recognition programs
*Benefit eligibility is dependent on employment status.
**About Amergis**
Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions.
Amergis is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
**Job Category:** Revenue Cycle
**Job Function:** Revenue Cycle | Inpatient Medical Coder | Inpatient Medical Coder
**Job Type:** Contract - Full Time
**Setting:** Healthcare Facilities
**Position Type:** Healthcare
**Office Number:** 0774
**Contract Duration:** 52
**Pay Rate:** $1520 / Week
**Date Posted:** T19:47:19
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Clinical Navigator (Remote)

21217 Baltimore CareFirst

Posted 15 days ago

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Job Description

**Resp & Qualifications**
**PURPOSE:**
The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both care management and utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care, and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working telephonically with the hospital care team including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge. The candidate may also be required to come to the CareFirst office location periodically for meetings, training, or other business-related activities. The candidate's primary residence must be within the greater Baltimore metropolitan area. Bilingual - fluent in Spanish a big plus!
**ESSENTIAL FUNCTIONS:**
+ Utilize clinical expertise and critical thinking skills to analyze available clinical information, Electronic Medical Records (EMRs), benefit contracts, mandates, medical policy, evidence based published research, national accreditation and regulatory requirements to aid in determination of appropriateness and authorization of inpatient clinical services. Engages telephonically with member, family and providers to identify key strategic interventions, discharge planning and coordination to address members medical, behavioral and/or social determinant of health needs to promote a safe transition to the appropriate level of care and/or home.
+ Collaborates with CareFirst medical directors and participates in internal case rounds/discussions to determine appropriate course of action and level of care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with benefit determination.
+ Makes referrals to other care management programs as appropriate for chronic, long-term care coordination.
+ Works collaboratively with hospital teams to develop positive working relationships to decrease provider abrasion and improve the member experience.
**QUALIFICATIONS:**
**Education Level:** Bachelor's Degree in Nursing OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
**Licenses/Certifications Upon Hire Required:**
+ RN - Registered Nurse - State Licensure And/or Compact State Licensure: RN - Registered Nurse in MD, VA or Washington, DC
**Experience:** 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review.
**Preferred Qualifications:**
+ Knowledge and experience with MCG
+ Experience working with Commercial and Federal Employee Program employee group member and Medicare/Medicaid enrollees and benefits contracts
+ CCM certification
+ MCG certification
**Knowledge, Skills and Abilities (KSAs)**
+ Strong interpersonal skills and the ability to engage in a member facing environment telephonically) while at the same time building relationships and partnerships with hospital care team and alternative care delivery partners to meeting member/enrollee needs.
+ Strong clinical documentation skills along with the ability to type on a computer keyboard with ease and speed.
+ Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and Power Point.
+ Strong analytical and problem-solving skills to judge appropriateness of member services and treatments on a case-by-case basis.
+ Knowledge of clinical standards of care and disease process and national, evidence based clinical guidelines and hospital operations.
+ Knowledge of available community resources and programs.
+ Basic understanding of the strategic and financial goals of a health care system, payer organization, health plan and/or health insurance operations (e.g. networks, eligibility, benefits).
+ Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
**Salary Range:** $72,360 - $143,715
**Salary Range Disclaimer**
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
**Department**
Maryland Inpatient Onsite
**Equal Employment Opportunity**
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
**Where To Apply**
Please visit our website to apply: Disc/Physical Demand**
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
**PHYSICAL DEMANDS:**
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
**Sponsorship in US**
Must be eligible to work in the U.S. without Sponsorship
\#LI-SS1
REQNUMBER: 21992
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