Case Manager 1 - Full-time / Part-time

Case Manager needed in Innsbrook, VA

Integrity Staffing Solutions is currently seeking a Case Manager in the Innsbrook area. Integrity Staffing Solutions provides comprehensive professional level staffing services on a nationwide basis and has been bringing companies and professionals together for over 12 years. At Integrity Staffing Solutions, we find the best, highest paying professional level positions within the top companies in the area. Most of the positions we identify will never be found in a newspaper or online because of the exclusive relationships we have with our clients who trust Integrity Staffing Solution's recruiting team to identify top talent to fill their critical hiring needs. Finding a top paying job at a great company is often like signing the contract of a lifetime; let us get to work for you today!

Our client offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Their customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. As the first national, full-service health insurer to offer a consumer-directed health plan, our client continues to lead the way with their full line of consumer-directed health care products.

Responsibilities:

• Initial review and triage of Care Team tasks
• Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools
• Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan
• Monitors non-targeted cases for entry of appropriate discharge date and disposition
• Identifies and refers outlier cases (e.g. Length of Stay) to clinical staff
• Identifies triggers for referral into Case Management, Disease Management, Mixed Services, and other Specialty Programs
• Utilizes eTUMS and other systems to build, research and enter member information, as needed
• Support the Development and Implementation of Care Plans
• Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services
• Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively)
• Performs non-medical research pertinent to the establishment, maintenance and closure of open cases
• Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems
• Adheres to Compliance with PM policies and regulatory standards
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• May assist in the research and resolution of claims payment issues
• Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/ or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures

Skills:

• 2-4 years' experience as a medical assistant
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members
• Computer literacy in order to navigate through internal/ external computer systems, including Excel and Microsoft Word
• Ability to effectively participate in multi-disciplinary team including internal and external participants
• Familiarity with basic medical terminology and concepts used in care management
• Effective communication, telephonic and organization skills

Additional Details:

• Hours: Full Time
• Pay Rate: $18.50
• Employment Type: Contract
• Limited medical and dental coverage for contractors and their families available immediately
• Opportunities for professional growth.

Integrity Staffing Solutions is an Equal Opportunity Employer. All job offers are contingent upon the successful completion of a background check and drug screen.

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