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We got a new job details in Arizona Priority Care & they are Hiring Candidates for Telephonic Care Manager
Company Name : Arizona Priority Care
Company Location : Chandler, AZ
Job Position : Telephonic Care Manager
Job Category : Jobs in Chandler, AZ
Job Description :
Participates in calling Medicare Advantage, (MA) members for the Telephonic Care Management Program and the COVID19 Program.
Performs ED follow-up calls.
Facilitates member/family/caregiver education through referrals to Complex Case Management, (CCM), Palliative Care, (PC) and Telephonic Care Management, and Hospice as appropriate.
Identifies any psychosocial needs of the member and facilitates referrals to social work and/or behavioral health, as necessary.
Documents relevant changes in qHMO of member’s condition or status, as they occur.
Acts as a backup to the concurrent review RN for performing the initial hospital admission review, and collaborates with AZPC Medical Directors, for medical necessity determination for in-network hospitalized members.
Performs re-reviews on all status changes, and collaborates with the Medical Director for appropriate status determination.
Writes appropriate rationales on all reviews that do not meet status requested.
9. Performs re-reviews on all disputed Provider Dispute Resolutions, (PDR’s) and collaborates with the Medical Director for medical necessity determinations.
10. Reviews Acute Rehab and Long Term Acute Care requests for appropriate disposition with the Medical Director, and informs the hospital case manager of decision.
Assists the Skilled Nursing Facility, (SNF RN) as needed to ensure timely and safe discharges..
Identifies and submits to the Quality Department any potential quality issues for review as well as utilization issues; e.g., over/under utilization, delay of service issues, etc.
Identifies and submits Potential Quality Incidents, (PQI)s to the Medical Director.
Equally shares in after-hours, week-end rotation and Holiday coverage for Care Coordination Department.
Strong teamwork philosophy and willingness to accept change proactively.
Other duties as assigned.
EUCATION, TRAINING & EXPERIENCE
1. Current unrestricted AZ Nursing license – BSN RN preferred.
2. Knowledge of Medicare, state, and local managed care regulations, prior experience in Managed Care setting preferred.
3. 5 years acute care or care management experience. Medical, ER, Tele, ICU or other relevant clinical role requiring quick critical thinking experience preferred.
4. Must have the ability to present clinical information both accurately and confidently.
5. Able to communicate effectively and in a professional manner with all levels of internal staff and external customers.
6. Ability to be detail-oriented, able to function under pressure and able to prioritize and re-prioritize tasks as needed.
7. Ability to work both independently and as part of a team, with minimal supervision.
8. Excellent customer service and communication skills, both oral and written.
9. Ability to navigate numerous Electronic Health Records systems.
Job Type: Full-time
Continuing education credits
Employee assistance program
Flexible spending account
Health savings account
Paid time off
Critical & Intensive Care
Hospice & Palliative Medicine
8 hour shift
Monday to Friday
Nursing: 1 year (Preferred)
Case management: 1 year (Preferred)
Willingness to travel:
Work Location: Multiple Locations
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