Accountability for the direct management and business operational functions of a 20+ associate call center focused on assessment, education, and support of medication adherence for patients of Optum care delivery organizations (CDO) Assist leaders with new development and continuous improvement of standard operating procedures inclusive of process flows, issues logs, audi

Answer and evaluate telephone inquiries regarding patient medical needs Conduct sound nursing assessments. May offer alternatives following established guidelines and protocols Refer inquiries to appropriate resource Perform data entry at time of call (where applicable) Promptly seek emergency interaction for the patient as needed Report situations needing administrative

Demonstrates clinical competence in the direct care of patients in established area(s) of practice, and assisting MDs with procedures Performs clinical duties within scope of practice complying with the accepted CareMount Medical and/or individual department standards, policies, and protocols Demonstrates a proactive approach to patient care, focusing on addressing each p

Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer Under direction and supervision of physician, administers medications, administers immunizations, EKGs, ear washes, and other patient services. Assists in simple office a

Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing Understands and complies with long term care policies and procedures, including those that regulate nursing facilities and assisted living communities Establishes and maintains effective relationships with members and their legal representatives, faci

Collaborate with business and technology teams to identify issues, establish objectives, develop recommendations, and implement solutions for our clients Identify, build, and deploy Project Management Office principles and standards utilizing project management tools Charter/Scope documents, Project Plan, IRAAD/Issue Log, Lessons Learned, Requirements Matrix, portfolio tr

Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica

Day to day Data Protection support dealing with customer concerns and requests Performance and Hardware monitoring of Data Protection infrastructure Hardware and Software maintenance and upgrades Create and maintain operational documentation Participate in the evaluation and selection of new products and technologies Ensure best practices and standards are being followed

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Review and analyze patient visit information to determine whether authorization is needed and understands payor specific criteria to appropriately secure authorization and clear the account prior to service where possible Ensure that initial and all subsequent authorizations are obtained in a timely manner May provide mentoring to less experienced team members on all aspe

Ensures excellent customer service when assisting patients, providers, and other departments Collects and updates patient demographic and insurance information, making changes as necessary to ensure accuracy with insurance benefits, referrals, and authorizations Verifies precertification/authorizations for scheduled services utilizing internet sites, payer contacts, and s

Obtain accurate and updated patient information, such as name, address, insurance information Perform insurance verification on the date of service Obtain patient signatures for required documents File and maintain medical records Confirms and schedule appointments Answering incoming and outgoing telephone calls promptly and courteously Perform referral documentation prom

Interview patients in a hospital setting and work effectively with hospital personnel to assist patients with obtaining maximum benefit coverage Complete applications for state and federal programs Review medical records and take all necessary actions to expedite benefit approval Adhere to company and legal standards regarding Protected Health Information (PHI), Personal

Delivers high quality patient care through face to face, telephone, and electronic contact for examination, treatment, monitoring, and preparation for diagnostic tests or procedures Collects and documents patient information, including vital signs, chief complaints, reviews of medications, allergies, health risk screening information, the status of extended care benefits,

Maintain a solid understanding of each of the assigned client businesses, their unique industries, and the services we provide them. Understand the client's needs on a day to day basis as well as a strategic level and how our services benefit them Develop strong working relationships with key contacts within each company including the decision makers, influencers, and coa