The Health and Wellness Clinical Support Team (HAWCST) supports Advanced Practice Clinicians (APCs) in the HouseCalls and Complex Care Management businesses by providing telephonic consultation to plan members and their healthcare providers in a call center environment, receiving and processing orders, providing member education on disease process, and coordinating care of members with other healthcare professionals. This team includes certified medical assistants, licensed practical nurses, nurse care managers, pharmacists and social workers.
The Licensed Practical Nurse (LPN) will report directly to the Supervisor of Clinical Operations of HAWCST. The LPN provides telephonic support to members and healthcare providers. They work to ensure members receive quality customer service by addressing questions and concerns, identifying the appropriate parties to triage calls to, entering urgent referrals into the electronic medical record (EMR) and other administrative tasks. The LPN will also play a supportive role to Nurse Practitioners (NPs) in the house call program. The LPN supports the clinical operations team by entering, processing and tracking the medical needs of the member.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Resolve concerns for members, providers, and APCs, triaging to the appropriate discipline when necessary (Dietitian, Nurse Care Manager, Pharmacist, Social Worker)
- Enhance the experience of both internal and external customers by providing excellent customer service
- Serve as a bridge between healthcare providers and members to answer questions/address concerns related to member care
- Retrieve and respond to voicemail messages, triaging as need
- Call members and/or providers with laboratory and/or test results as needed
- Access health plan portals to verify benefit eligibility/benefits for patients and seek additional information as necessary
- Obtains medical records when requested by a provider
- Perform data entry and complete documentation of calls
- Perform data entry into the EMR utilizing information from an electronic or hardcopy source (referred to as the ISNP Backfilling process)
- Input/update patient PCP/demographic into EMR and computer database systems
- Enter internal referrals to Social Work and Case Managers and locate community resources for members as directed by providers
- Uploads Informed Consent, ROI, POA, and other documents as necessary into EMR
- Enter/process/track patient referral data (e.g., medical services, radiology, durable medical equipment, lab orders, specialist referrals) and follow up until completion
- Generate reports on patient data through relevant computer systems/applications
- Review/analyze patient data reports (e.g., discharges, hospital admissions/readmissions, skilled nursing facilities) and follow up as necessary
- Manage internal health plan mailboxes/task boxes in the EMR
- Ensures PCP communication via auto fax or manual fax of visit notes
- Demonstrate understanding of Federal privacy regulations (e.g., HIPPA) and safety guidelines/practices (e.g., OSHA)
- Ensure that all phone interactions meet quality standards set by the department
- Participate in and contribute to staff meetings and other staff development opportunities and interdepartmental work groups
- Provide cross-coverage support across the team support and assist with special projects, as needed
- Work with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies
- Assume other duties as assigned by Supervisor or Manager
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- High school diploma or GED
- Current and unrestricted compact LPN licensure
Preferred Qualifications:
- Bachelor’s degree pPreferred in nursing, health education, nutrition, exercise physiology, or closely related field)
- Experience in call center customer service
- Intermediate level of proficiency in PC-based word processing and database documentation (Microsoft Word, Excel, Outlook)
- Bilingual
Soft Skills:
- Strong organizational skills
- Strong verbal and written communication
- Ability to apply critical thinking skills to prioritize and perform responsibilities to meet deadlines
- Strong interpersonal skills
- Ability to work well with a team and maintain a positive attitude.
- Adaptable to rapidly changing priorities
- Ability to be flexible, open to new ideas
- Demonstrate a willingness to take on new responsibilities
- Ability to type 30-40 words per minute
We’re making a strong connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that’s driving the health care industry forward. As a Telephone Case Manager RN, you’ll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today!
Work hours Monday – Friday 40 Hour Work Week – 2 evenings per week you must be able to work until 8:00 p.m. in your time zone.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Make outbound calls to assess members’ current health status
- Delivers clinical support to members across a wide array of health topics and conditions
- Identify gaps or barriers in treatment plans
- Provide patient education to assist with self-management
- Make referrals to outside sources
- Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction
- Collaborates with specialists, physicians, and medical/clinical directors to provide the necessary care and cost-efficient care for the customer
This is high volume, customer service environment. You’ll need to be efficient, productive and thorough dealing with our members over the phone. Solid computer and software navigation skills are critical. You should also be patient-focused and adaptable to changes.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Current, unrestricted RN license in the state of employment
- Willing to obtain additional RN licenses
- Certified Case Manager (CCM) or the ability to obtain certification within 30 months of employment
- 3+ years of clinical experience in a hospital, acute care setting
- Excellent typing skills and able to navigate a Windows based environment
- Intermediate or greater level of proficiency with Microsoft Office
- Access to high speed internet
- Dedicated work area established that is separated from other living areas and provides information privacy
- Ability to work hours as outlined above
Preferred Qualifications:
- BSN Degree
- CCM (Certified Case Manager)
- Active Compact license
- Background in managed care
- Case management experience
- Experience or exposure to discharge planning
- Experience in a telephonic role
- Bilingual English / Spanish   Â
- Ability to work independently with minimal supervision
Customer Success Strategist Specialist
- Customer Success Strategist/Specialist (Remote)
- As a Customer Success Strategist, you will be the primary contact for a defined group of clients, guiding them along a path to success and engaging resources across Change Healthcare to show benefits of and opportunities presented by clinical decision support CDS.The ideal candidate will be as passionate about our CDS solutions as they are about providing an exceptional experience for every customer and are motivated by shared success. We’re looking for a driven team member who is interested in using their customer relationship, organization, and technical skills to help us achieve our goal of being a trusted and valued partner for our customers and to help Change Healthcare make long lasting, positive changes in the healthcare industry.You will own the post-implementation relationship and experience for our customers, driving value realization and cultivating cycles of continuous improvement. You are a relationship builder with a successful track record of building rapport with customers. You are able to evaluate plans and execute with high quality and timeliness on individual action items and details. As a first point of contact for issue resolution, you can proactively identify and resolve customer needs, both independently and in coordination with other team members to ensure needs are addressed in a complete and timely fashion.What will I be responsible for in this job?
- Establish and maintain strong relationships with assigned customers.
- Work closely with other areas including product development and sales to ensure customer needs are met and feedback is shared. Understand product goals and communicate that with customers.
- Communicate company priorities and roadmap with customer in relation to issues and enhancements.
- Deliver strategically-relevant analytics to show customer value of CDS product(s).
- Work cross-functionally within the organization to ensure deliverables are met and to promote client customer satisfaction.
- Communicate on a regular basis with the customer to ensure optimization plans and objectives are on track and met.
- Coordinates updates to the configuration and content of CDS as needed and agreed upon with the customer.
- Serves as a point of escalation for the customer within Change Healthcare.
- Focus on efficiency and high impact work.What are the requirements needed for this position?
- Years of experience: 2+ years work experience in Healthcare IT, and/or customer implementation and support in the healthcare services industry.
- Education: Bachelor’s degree or equivalent work experience preferredWhat critical skills are needed for this position?
- Language Skills – Advanced interpersonal, written and verbal communication skills with proficiency in a variety of settings and audiences, including IT professionals, executives, and clinicians
- Reasoning Ability – Advanced reasoning and problem-solving proficiency.
- Strong project and task management skills
- Strong customer service skills and background.
- Detail oriented
- Proficient in Microsoft Office products, especially Excel
How much should I expect to travel?
- Travel to Change Healthcare offices or client sites occurs on an as-needed basis. Expect 0-5 trips per year.
- Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.
- Augusta, ME
- Overview of Position
The Provider Relations Coordinator will assist in answering Pharmacy Questions presented to Provider Relations e-mail address, assist in contracting, 835 and remittance research, concurrent review of pharmacy Network, pharmacy network set up and maintenance.What will be my duties and responsibilities in this job?- Operational support and maintenance of the multiple pharmacy networks within the SelectRx claims adjudication operating platform
- Assist in building a new infrastructure for our Pharmacy networks.
- Support of the HP financial interface with the SelectRx system to ensure proper pharmacy payment processes, new payment process and transition, maintenance of UPBS
- MAC list support and pharmacy inquiries
- Client Payer Sheet maintenance and support
- Self-pay and VOD payment support
- Support NCPDP pharmacy file loads and verification to ensure pharmacy payments
- Pharmacy network oversight and concurrent review
- Support on-going pharmacy network support for collection of pharmacy administrative fee
- Other duties as assignedWhat are the requirements needed for this position?
- Required: High school diploma or equivalent work experience
- Prefer Pharmacy related experience such as Pharmacy Tech, Customer Service
- PBM or related experience working with contracts or pharmacy claim detailWhat other skills/experience would be helpful to have?
- Advanced knowledge of Pharmacy Claims processing
- Access Database and Excel programs
- Proficient in analytical metrics and trending reports
- Ability to meet position metrics goals (OKR’s)
- Organized
- Detail Oriented
- Ability to multi-task
- Work well with others
- Computer literate
Position Summary:
The Pre-Certification Specialist is responsible for supporting the Precertification Nurse, Medical Director and Director of Health Services by collecting, interpreting and evaluating medical information received for authorization. The Pre-cert Specialist will communicate with internal and external providers regarding authorization status.
Essential Duties and Responsibilities:
- Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal
- Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)
- Determine authorization requirements based on company policy, member benefit grid and provider status
- Review customer coverage and benefits
- Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse)
- Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
- Professional demeanor and the ability to work effectively within a team or independently
- Flexible with the ability to shift priorities when required
- Maintains regular and acceptable attendance in accordance with Time Away From Work policy
- Ability to work evening, weekend and holiday shifts to support the UM Department
- Other duties as requested
Qualifications:
- High School Diploma and preferred 1-2 years’ experience in a managed care environment
- Proficient in medical terminology, CPT, HCPCS and ICD-10 coding
- Effective oral and written communication skills
- Strong customer orientation
- Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word
- Excellent typing skills
Knowledge, Skills, Abilities Required:
- Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer
- Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment
- Proficient knowledge of departmental policies and procedures
- Knowledge of Medicare Regulatory Requirements
This role is Flex/WFH which allows most work to be performed at home or on occasion at a Cigna office location. Employees must be fully vaccinated if they choose to come onsite.
This position is not eligible to be performed in Colorado.
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