<![CDATA[A-Line Staffing Solutions LLC: jobboards]]> http://JOBS.ALINESTAFFING.COM/ en-us <![CDATA[Representative]]> Overview:
  • Scheduling of customer orders by phone.
  • Reviewing pertinent patient info and noting in operating system.
  • Ensuring timely dispensing so as to compliance of therapy.
  • Working with various internal and external departments including but not limited to Admissions, Billing, Pharmacy, Medicaid and private payors.
  • Ideal candidates that will be selected for the in person interviews will be given basic pharmacy math test.
  • Candidates must have intermediate computer skills and excellent communications skills.

 

Description:
  • Effective delivery of company products and services.
  • Responds to telephone inquiries and orders from homecare patients and referral sources.
  • Provides information on equipment, supplies and services.
  • Determines the best method for providing services. 
  • May assist walk-in patients with the selection of equipment, supplies and services.
  • Timely processing/facilitation of patient orders.
  • Processes telephone orders by preparing patient paperwork. 
  • Verifies insurance and/or other method of payment.
  • Completes all necessary paperwork in an accurate and efficient manner to facilitate the data entry, accounts receivable and delivery of the order placed.
  • May perform data entry.
  • Distributes copies of paperwork to appropriate personnel.
  • May assist with the processing of billing paperwork.
  • Effective coordination of patient services/supplies.
  • Coordinates the delivery, set-up and pick-up of equipment, supplies and services with appropriate personnel.
  • Ensures deliveries and set-ups can be arranged in a timely manner.
  • Appropriate documentation.
  • Accurately maintains files of all patient account profile information and referral source data.
  • Customer satisfaction.
  • Resolves patient complaints by identifying problems and coordinating appropriate corrective action.

Duties:
  • Knowledge of Medicare, Medicaid, and 3rd party vendors is a plus.
  • The primary responsibilities are to verify insurance coverage for potential new clients.
  • Additionally, this person will re-verify insurance coverage for existing patients in order to process patient prescription needs successly and demonstrate excellent customer services to patients, healthcare professionals, and insurance carriers.
  • This role will require an understanding of insurance concepts, including drug cards, major medical benefits, and per diem coverage, as well as knowledge of government and patient assistance programs.
  • Strong attention to detail, and proven analytic and problem solving.

 

Experience:
  • Minimum of 1 year in a customer service or call center environment (call center type environments preferred, if doctor's office.
  • Must have effective and empathetic communication style in managing inbound calls and communications with clients and team members.
  • Computer experience is required with proficiency in Microsoft Outlook, Word and Excel. * Basic alpha number data entry skills with attention to accuracy and quality is essential.
  • Intermediate math skills are required with attention to detail and quality essential. 
  • Experience in a health care setting or insurance industry is a plus, including knowledge of basic insurance and third party terms and medical terminology. 
  • Ability to work with people in a team environment while meeting individual performance goals. 
  • Must be able to read and interpret policies, procedures and instructions.
  • Effective organizational skills and ability to prioritize a fluctuating workload and competing priorities is essential.

Education:
  • High School diploma or GED.
  • PHARMACY TECHNICIAN STATE LICENSE STRONGLY PREFERRED
    MINIMUM OF ONE YEAR EXPERIENCE IN RETAIL OR HOSPITAL SETTING, OR PHARMACY CALL CENTER SETTING.

Hours:
  • The ideal candidates MUST be open to work any of the following shifts.
  • The shifts might be rotating during the assignment, and should be available from 7: 30 am to 7: 30 pm Monday through Friday.
  • 5 shifts will be offered.
  • 7: 30am -4pm
  • 8: 30 am-5: 00pm.
  • 9: 30-6: 00 pm.
  • 10-6: 30 pm.
  • 11: 00am- 7: 30pm.

For more information, contact our office at 877-782-3334.

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Mon, 27 Aug 2018 00:00:00 CDT 0
<![CDATA[Customer Service Representative]]> Description:
  • Looking for 5 possible contract to hire for Customer Service Representatives.
  • Prefer at least a HS Diploma and some college but HS Diploma is required.
  • Hours could be 8-5: 30 or 9-6: 30.
  • Support all Diabetic DME.
  • 30-50 calls per day, mostly inbound.
  • Should have above average Data Entry & Computer skills.
  • Dealing with Prior Auth, Insurance Verification, Coordinating Patients care and Dr. Visits.
  • Looking for candidates with ability to show empathy and that have a good, outgoing personality.

For more information, please contact our office at 877-782-3334.

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Fri, 24 Aug 2018 00:00:00 CDT 0
<![CDATA[Project Manager]]> Description:
  • The Loyalty and Personalization Consultant job will build, execute, and measure cross-channel campaigns to deliver highly personalized offers and communications to our customers.
  • Ability to multitask several requests, quickly assemble data and generate impactful insights in a fast paced environment are necessary characteristics to succeed in this role.

Duties:
  • Write SQL queries to run complex analysis on large datasets to derive insights.
  • Ability to automate processes.
  • Generate campaign analytics to understand the effectiveness of L&P programs.
  • Deliver insights around L&P programs to enhance future programs.
  • Present findings to the leadership team and various other functional groups throughout retail.
  • Conduct Adhoc Analytics and support for various functional groups throughout retail and all other duties as assigned.

Experience:
  • Bachelor's degree in statistics, mathematics, computer science, quantitative economics or related field.
  • 5 to 7 years in an analytical role coupled with presentation and leadership capabilities.
  • Highly proficient use of SQL for extraction and manipulation of data.
  • Highly proficient use of Tableau.
  • Experience using SAS.
  • Analytical mindset with detail orientation.
  • Ability to multi-task several concurrent requests.
  • Ability to quickly pull together data and generate impactful insights.
  • Must be able to create and deliver presentations to management.
  • Ability to concisely explain complex analytical finding to non-analytic peers and internal customers.
  • Solid understanding of retail and/or data driven marketing.
  • Must have advanced skills using Microsoft Excel and Microsoft Power Point.

Education:
  • Bachelor s Degree in Computer Science, Business Administration, Engineering or r elated discipline with information technology focus.
  • Project Management Certification (PMP) is preferred.
  • Applied, proven knowledge of Software Engineering Institute (SEI), Software Quality Assurance (SQA), Capability Maturity Model Integration (CMMI) disciplines, ITIL standards and principles preferable.

Hours:
  • Mon- Fri.
  • 8: 30-5: 00.

For more information on this position, please contact our office at 877-782-3334.

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Fri, 24 Aug 2018 00:00:00 CDT 0
<![CDATA[Prior Authorization & Referrals Manager]]> Description:
  • Oversee day to day functions of the call center that provides preauthorization and referral services to physicians for plan members.
  • Oversee preauthorization nurses and referral specialists in their day to day activities including management of talk times, service levels, abandonment rate, and other key quantitative/qualitative factors.
  • Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions.
  • Promote compliance with federal and state regulations and contractual agreements.
  • Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.
  • Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.
  • Facilitate on-going communication between utilization management staff and contracted providers.


Education/Experience:
  • Bachelor s degree in related field or equivalent experience.
  • 4+ years of nursing experience.
  • Call center/customer service experience and working knowledge of call center technologies, data, and reporting.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
  • License/Certification: RN license.

For more information on this position, please contact our office at 877-782-3334.

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Wed, 22 Aug 2018 00:00:00 CDT 0
<![CDATA[Representative]]> Description:

  • Knowledge of Medicare, Medicaid, and 3rd party vendors is a plus.
  • The primary responsibilities are to verify insurance coverage for potential new clients.
  • Additionally, this person will re-verify insurance coverage for existing patients in order to process patient prescription needs successly and demonstrate excellent customer services to patients, healthcare professionals, and insurance carriers.
  • This role will require an understanding of insurance concepts, including drug cards, major medical benefits, and per diem coverage, as well as knowledge of government and patient assistance programs.
  • Strong attention to detail, and proven analytic and problem solving.

Experience:
  • 6+ months of experience with medical insurance, benefits verification, medical billing or a related field.
  • 1+ years of experience in a Windows based computer utilizing Microsoft Office.
  • Pharmacy, PBM or Specialty pharmacy experience.
  • Knowledge of government and patient assistance programs.
  • Excellent customer service skills.
  • Attention to detail.
  • Analytical and problem solving skills.
  • Experience working with medical billing procedure.
  • Previous experience working with Prior Authorizations.
  • Knowledge of Medicare, Medicaid, and third party vendors.

Education:
  • High School diploma or GED.

For more information, please contact our office at 877-782-3334.

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Wed, 22 Aug 2018 00:00:00 CDT 0
<![CDATA[Registered Nurse]]> Description:
  • This position ensures that authorization requests and provider inquiries are handled appropriately within established timeframes, and established guidelines and protocol are utilized for clinical decision-making.
  • Functions collaboratively with the members of the Utilization Management team, and specifically with the review nurses, case managers and Medical Directors to ensure for timely disposition of inpatient authorization requests and discharge planning activities.
  • Oversee the queue workload needs on a concurrent basis including the inpatient authorization queues and the inpatient fax queues in the UM department to concurrently prioritize self-assignment for greatest impact on department function.
  • Support orientation program for UM staff by acting as primary mentor for review nurses, UM specialists and physician reviewers.
  • In conjunction with medical leadership, act as resource for criteria and benefit interpretation including the correct and consistent application of the InterQual criteria on the appropriate topics, consistent application of procedural practices established by client.
  • Supply ongoing training and education to the staff through one-on-one and classroom settings regarding InterQual, National Committee for Quality Assurance (NCQA), URAC or general accreditation, MDCH and other necessary job-related skills.
  • Collaborate with the Disease Management, Quality Improvement, and Utilization Management departments in the development of protocols and guidelines designed to standardize care practice and care delivery.
  • Seek out opportunities to improve HEDIS, NCQA, URAC or general accreditation and QIA activities.
  • Receive and review all emergent inpatient admission and observation notifications.
  • Review clinical data against established protocols/guidelines and within established timeframes to determine disposition of admission authorization requests.
  • Complete authorization process in system for approved authorizations and contact hospital reviewers with decision, days authorized and corporate authorization number.
  • Contact hospital reviewers where additional information is necessary to make a decision.
  • Consult with Medical Director as appropriate for all requests that do not meet criteria for admission and inform hospital reviewers of the Medical Director's decisions
  • Create and fax/mail denial letters to hospitals as required and within established timeframes.
  • Receive and process clinical updates for continued stay.
  • Initiate and follow through on all aspects of discharge planning, including, but not limited to, identification of needs, coordination of care and transitioning to alternate levels of care.
  • Collaborate with inpatient reviewers and other staff for discharge planning needs or transfer to alternative level of care.
  • Performs post discharge calls to members post inpatient, SNF and acute rehabilitation services in accordance with department guidelines.
  • Assists to coordinate follow-up appointments, home health care services, pharmacy services, and refer to care coordination or complex case management and/or community resources as indicated.
  • Monitor documentation, follow up calls to members are made in a timely manner according to follow date set and acuity level.
  • Coordinates activities with other medical management departments as needed, including making referrals to Case Management and Behavioral Health.
  • Communicate with providers and members on an ongoing basis to facilitate compliance and competency with established programs and guidelines to assist with decrease ER visits.

For more information on this position, please contact our office at 877-782-3334.

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Wed, 22 Aug 2018 00:00:00 CDT 0
<![CDATA[RN ER]]> Description:
  • 2 years recent ED experience in Level 2 Trauma Center.
  •   Must work the needs of the department.

Hours:
  • 3: 30pm-4: 00am.

For more information on this position, please contact our office at 877-782-3334.

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Tue, 14 Aug 2018 00:00:00 CDT 0
<![CDATA[RN Psychiatric]]> Description:

  • Registered Nurse position on inpatient psychiatric floor.
  • Behavioral health functions as a service line and all staff are trained and required to float between inpatient and outpatient psychiatry units.
  • Inpatient consist of 18 beds and out patient consist of 21 stretchers and ten walk in capacity.

For more information on this position, please contact our office at 877-782-3334.

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Thu, 09 Aug 2018 00:00:00 CDT 0
<![CDATA[Administrative Assistant]]> Description:
  • Manage calendars for designated department members.
  • Set-up and coordinate internal and external meetings/conference calls and prepare minutes where assigned.
  • Arrange travel, Answer phones and take and relay voice mail and email messages.
  • Prepare and maintain expense reports, purchase orders, vendor payment and reconciliation.
  • Order and maintain inventory of supplies and equipment, as well as maintain and reconcile various department purchase cards.
  • Provide organization support for Medicare Part D including presentation development (PowerPoint), database management (Excel), limited project management and other tasks as needed.
  • Interact professionally with all levels of internal and external personnel via phone, in person, and via written correspondence.
  • Establish contacts with other internal and external customers. Institute solutions for the administrative needs of the department.
  • Complete other duties as assigned.

Experience:
  • 3+ years Administrative Assistant experience required.
  • Customer service experiences a plus.
  • Ability to communicate effectively with employees, customers and clients.
  • Word processing/PC skills required.
  • Experience with Microsoft Office applications.
  • Strong communication skills required.

Education:
  • Verifiable High School Diploma or GED is required.
     

For more information on this position, please contact our office at 877-782-3334.

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Thu, 09 Aug 2018 00:00:00 CDT 0
<![CDATA[Pharmacy Tech]]> Description:
  • This position takes in-coming calls from members, providers, etc providing professional phone assistance to all callers through the criteria based prior authorization process.
  • Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist.

Experience:
  • At least 1 year experience as a pharmacy technician coordinating activities in an administrative support function.
  • National pharmacy technician certification.
  • Eligible for state registration, certification or licensure per state regulations.
  • Advanced computer skills including word processing and spreadsheet utilization.
  • Excellent customer service skills (written and verbal) a must.
  • Minimum (1) year experience required in a customer service position with high volume call center experience; preferably in healthcare, social services, or a similar service position.

Education:
  • Verifiable High School diploma or GED is required.
  • Must be licensed in IL as pharmacy technician, certification is highly preferred.

For more information on this position, please contact our office at 877-782-3334.

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Tue, 07 Aug 2018 00:00:00 CDT 0
<![CDATA[RN Labor and Delivery]]> Description:
  • 2 years recent LDRP experience required.
  • Must work the needs of the department and every other weekend.
  • 7: 00am-7: 30pm.

Please contact our office if interested at 877-782-3334.

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Tue, 07 Aug 2018 00:00:00 CDT 0
<![CDATA[Project Manager]]> Overview:
  • Seeking a Sr. Advisor of Campaign Execution who will lead a team that will take a hypothesis-driven approach to surface consumer and campaign insights that can be turned into actionable executable campaign plans.
  • You will have the ability to multi-task, be able to quickly transform data into actionable customer centric insights in energizing environment.
  • The Sr. Manager will be able to delegate across a large team of execution analysts, as well as having the ability to dig down into the details and understand the all aspects of the tactics.

Responsibilities:
  • Lead a team that will work with a multitude of business partners to transform high level business strategy into executable, scalable, and maintainable omni-channel campaigns.
  • Ability to manage larger teams, including task delegation, balancing work loads, triaging critical production issues as they arise, and handling priority assignment with tactics across multiple channels.
  • Ability to be hands on with CRM systems and with data, to build omni-channel campaigns, but also delegate tasks to team members while and ensuring execution best practices are followed.
  • Have a strong understanding of measurement to ensure all needed KPI s in new and existing campaign can be measured and reported.
  • Work with our business partners to develop solutions for campaign needs.
  • Utilize SQL and SAS (and other statistical tools) to develop data driven customer insights.
  • Participate and lead project teams that utilize customer behavior information in their marketing processes, including Merchandising, Loyalty and Promotional Planning.

Experience:
  • 5-8+ years of execution experience in database marketing, direct marketing and/or marketing research analyses OR several years of direct project organization on direct marketing or highly analytical customer engagement projects. 
  • 5+ Years of team leadership skills in the marketing and technology industry.
  • 5+ years CRM analytics experience in 1: 1 targeted campaign environment, preferably involving rapid test & learn setup.
  • Experience working in small teams in high pressure environments.
  • Experience developing hypothesis-based solutions and strategies.
  • Experience presenting analytical findings to audiences at all levels.
  • Ability to concisely explain complex analytical finding to non-analytic peers and internal customers.

Preferred Qualifications:
  • CRM, ESP, marketing cloud, or other personalization technology experience (e.G., Teradata, IBM Unica, Adobe, Dunnhumby, Oracle, Datalogix).
  • Experience managing processes required to maintain large scale reporting and insights systems.
  • Retail experience.
  • Experience with loyalty programs Knowledge of PowerPoint, Excel, Outlook, Word.
  • Loyalty program experience is a plus.

Education:
  • Bachelor's degree in statistics, mathematics, computer science, quantitative economics or related field.
  • Master's degree preferred.

For more information on this position, please contact our office at 877-782-3334.

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Wed, 25 Jul 2018 00:00:00 CDT 0
<![CDATA[Recruiting Assistant]]> A-Line Staffing Solutions is a recruiting and staffing company that specializes in placing Healthcare, IT and Professional/Administrative candidates.

We are hiring internally due to our growing client base and brand-new facility in downtown Utica!

Currently seeking Recruiting Assistants to join our team!

Pay: $13 per hour

Hours:
8: 00am - 5: 00pm Monday - Friday

Job Description:
  • Entry-Level Position! Room for Growth!
  • The position is designed for high-energy, motivated individuals with little to no recruiting experience!
  • Learn to perform Full-Cycle Recruiting for our Healthcare Clients.
  • Post Job Postings to various job boards
  • Outbound calls to prospective candidates on the job boards
  • Communicate with candidates regarding job details / screening
  • Scheduling interviews and preparing candidate for success prior to interview
  • Maintain good relationship with all candidates, employees and corporate clients
  • Assist candidate and HR with on-boarding of new employees to ensure that all documents are completed
  • Performs other duties as assigned

Requirements:
  • Must be dependable, flexible, and exhibit outstanding customer service and interpersonal communication skills
  • Ability to handle sensitive and confidential personnel matters
  • Excellent at multi-tasking and quickly switching gears (required)
  • Typing speed of at least 40 wpm
  • Working knowledge of MS Office applications (Windows 7, Word, Excel, PowerPoint, Outlook)
  • High School Diploma/GED required

Additional Great Benefits to A-Line Staffing Solutions:
  • Health, Dental, Vision, and Life Insurance available on day 91
  • 401K with company match available
  • Paid Holidays
  • Competitive PTO

Interested? Apply to this job posting right away for immediate consideration or call our office at  877-782-3334.

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Fri, 18 May 2018 00:00:00 CDT 0
<![CDATA[Pharmacy Technician]]> Description:
  • Seeking  a full-time Pharmacy Technician Lead to support our clients local pharmacy.
  • The lead pharmacy technician holds a leadership position in which they must provide guidance and instructions to other pharmacy technicians.
  • The schedule for this position is 9: 00 am to 6: 00 pm M-F (Saturday hours are optional).

Duties & Responsibilities:
  • Create bills and medicine labels.
  • Maintain inventory and track restocking.
  • Whenever discrepancies are noted, the pharmacy technician must notify the pharmacist immediately.
  • Under direct supervision of the registered pharmacist fills compounds and prescription orders and makes them available for verification by the Pharmacist.
  • Once verified by the pharmacist, dispenses the prescriptions.
  • Order, receive and store incoming pharmacy supplies.
  • Receive and process wholesaler medication orders.
  • Verify medication stock and enter data in computer to maintain inventory records.
  • Help maintain a clean organized work environment.
  • Perform various clerical duties as needed.
  • Work with the pharmacist to assist in the pharmacy functions and keeping the pharmacy in compliance with all federal and state requirements.
  • Occasional medication delivery to consumers.
  • Provide exceptional customer service.
  • Other Duties as assigned.

Qualifications:
  • Must be a  Michigan licensed/registered Pharmacy Technician (CPhT).
  • Two years of retail Pharmacy Technician experience is highly preferred.
  • Candidates for the position will be subject to a standard reference, background check and drug screening.
  • Knowledge of Microsoft Office and telephone protocol.
  • Professional verbal and written communication skills.

For more information, please contact us at 877-782-3334.

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Fri, 04 May 2018 00:00:00 CDT 0
<![CDATA[Hardware Controls Designer]]> Job Description

Client is seeking an experienced hardware controls designer. This position will be responsible for industrial controls systems design; under the supervision of the assigned Controls Engineer. Must have proven experience in PLC and / or Servo system design with any of the following hardware systems: Bosch Rexroth, Rockwell, Modicon, GE Fanuc, Siemens, Mitsubishi, Omron, etc.

Responsibilities
  • Panel design and layout, bill of materials, and wiring schematic capabilities are expected with this position.
  • This designer must be able to work with minimal supervision and perform all required normal engineering calculations associated with this type of hardware design.
  • All designs will normally be done using AutoCAD.

Skills/Experience
  • E-Plan experience would be an added benefit
  • The ideal candidate will have a proven track record in engineering design as well as the ability to implement standard engineering practices, and provide detailed documentation upon project completion.
  • A minimum of 3 years experience in a similar position is required.
  • Experience in Automotive, Food Processing, or Water/Wastewater industries is a plus.

Attractive compensation package including:
  • Health insurance
  • Dental insurance
  • Vision insurance
  • Life insurance
  • Short and Long Term disability insurance
  • 401k
  • Paid holidays
  • Paid PTO

For more information, contact us at 877-782-3334.

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Thu, 05 Apr 2018 00:00:00 CDT 0
<![CDATA[RN Home Health]]>

Job Description:
  • RN will be providing skilled visits to patients in their homes.
  • RN will be expected to provide 5-6 visits daily.

Responsibilities:
  • RN will be responsible for setting up schedule with patients.
  • RN will be responsible for obtaining documentation.
  • RN will conduct assessments, resumptions, wound care visits etc.

Qualifications:
  • Must have an active RN license in the state of Michigan.
  • Must have Home Health experience.
  • Must be willing to travel.
  • Must have reliable transportation.
  • Must have Auto Insurance.

For more information, please contact  our office  at 877-782-3334.

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Wed, 21 Feb 2018 00:00:00 CST 0
<![CDATA[Psychiatrist]]> Job Description:
  • Doctor will see patients, review charts & sign off at  1-2 nursing homes per day (all near one another)
  • Psych evals, Med Reviews and History of Illness
  • Psychiatrist will be provided a scribe or transcription service and a Clinical Assistant for charting & all paperwork.

Requirements:
  • BE / BC (Board Eligible or Board Certified)
  • Psychiatrist to travel to Nursing Homes in Grand Rapids, Hudsonville, Kalamazoo and surrounding cities.

For more information, please contact our office at 877-782-3334.

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Thu, 01 Feb 2018 00:00:00 CST 0
<![CDATA[Case Manager]]> Top Skills:
  • 2-4 years of clinical experience in a hospital or other acute care setting.
  • Knowledge/experience with case management and disease management principles, discharge planning & chronic diseases
  • Strong knowledge/experience with computers, typing and Microsoft Office programs (Word, Excel, Outlook)

Job Details:
  • Utilizing a collaborative process, the case manager will assess, plan, implement, coordinate, monitor, evaluate and advocate the options and services required to meet an individual s health needs, using communication and available resources to promote quality, cost effective outcomes. The case manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source.
  • Assessment - The case manager will collect in-depth information about a person s situation and functioning to identify individual needs in order to develop a comprehensive case management plan that will address those needs.
  • Planning - The case manager will determine specific objectives, goals and actions as identified through the assessment process. The treatment plan is developed in collaboration with the member/authorized representative, treating physician, medical consultant, and, if appropriate, the social worker and keeping all parties informed of the treatment plan progress. The treatment plan should be action oriented and time specific.
  • Implementation - The case manager will execute specific intervention that will lead to accomplishing the goals established in the case management plan.
  • Coordination - The case manager will organize, integrate and modify the resources necessary to accomplish the goals established in the case management plan. Identify and coordinate services so that the member s health care needs are met across the continuum of care using the most effective means available.
  • Monitoring - The case manager will gather sufficient information from all relevant sources in order to determine the effectiveness of the case management plan.
  • The case manager will act as the liaison between the member/authorized representative and the facility, provider, and/or client management team through regular contact and collaboration with the member and provider(s) contacting the member/authorized representative on a regular basis
  • Evaluation - At appropriate and repeated intervals, the case manager will determine the plan s effectiveness in reaching desired outcomes and goals. This process might lead to a modification or change in the case management plan in its entirety or in any of its component parts.
  • Advocate - The case manager will advocate on behalf of the member/authorized representative.
  • Conducting a thorough and objective evaluation of the patient s current status including physical, psychological, environmental, financial, and health status expectation.
  • As a patient advocate, seek authorization for case management from the recipient of services (or designer)
  • Assessing resource utilization and cost management; the diagnosis, past and present treatment; prognosis, goals (short and long term).
  • Identifying opportunities for intervention.
  • Assisting members in meeting and managing both health care and quality needs
  • Setting goals and time frames for goals appropriate to the individual.
  • Identifying quality of care and savings opportunities, negotiating with providers when needed, facilitating the use of appropriate extra-and-contractual benefits, and providing the member with information or links to community, state, and/or federal resources.
  • Maintaining communications and collaborating with patient, family, physicians and health team members and payer representatives.
  • Comparing the patient s disease course to established pathways to determine variances and then intervene as indicated.
  • Introducing, assessing, opening, managing, closing assigned cases with guidance from the POD leader and physician consultant.
  • Routinely assessing patient s status and progress; if progress is static or regressive, determines reason and proactively encourages appropriate adjustments in the care plan, providers and/or services to promote better outcomes.
  • The case manager will document patient profile updates, discuss cases with POD leaders, and schedule case reviews with the physician consultants on a routine basis.
  • Establishing measurable goals which promotes evaluation of the cost and quality outcomes of the care provider.

  • Reporting quantifiable impact, quality of care and/or quality of life improvements as measured against the case management goals.

Education and/or Experience:
  • Registered Nurse with current Michigan License required
  • Nursing Diploma or Associates Degree in Nursing
  • Bachelor s degree in Nursing or related fields (preferred)
  • CCM certification (preferred). If not certified upon hire, encouraged to become CCM certified within four (4) years of functioning in a case management role
  • Certification in Chronic Care Professional (preferred)
  • Two (2) years full time equivalent of direct clinical care to the consumer
  • Two (2) to four (4) years of clinical experience preferably in Case Management or Home Health Care with a Medical/Surgical background
  • One (1) to three (3) years experience with client (preferred)
  • Working knowledge of Case Management principles and procedures based on nationally recognized standards of Case Management

For more information, please call our office at 877-782-3334.
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Mon, 22 Jan 2018 00:00:00 CST 0