$23.00 to $25.00 hourly
Robert Half Healthcare Practice is looking for a Care Manager for a hospital in San Francisco. If the idea of playing an integral role in a reputable hospital excites you, then this role may just be for you! If you're interested, please review the responsibilities and requirements below and send your updated resume to [ Email removed ] - URL blocked - click to apply
Responsibilities: • Knows, understands, incorporates, and demonstrates the Optum360 and client Mission, Vision, and Values in behaviors, practices, and decisions. • Demonstrating excellent customer service skills by facilitating communication between the hospital facilities and the payers. • Demonstrating effective assessment skills relative to providing adequate documentation and/or response as requested and/or required by the payers. • Accommodating payer requests for clinical reviews and Medical Record • Facilitating verbal discussion between the respective facility and the payer, as required. • Becoming knowledgeable of payer assigned time frames • Collaborating and alerting facility Case Managers of: a) Additional payer needs b) Requests for concurrent or retrospective review c) Physician Advisor review • Providing support in the certification process to ensure timely authorization of inpatient days followed by timely and accurate documentation. • Providing communication and/or documentation, as required, in order to ensure concurrent certification and payer updates via MIDAS. • Facilitating the scanning, copying, and mailing of documents for deferred cases or for cases involved in a concurrent clinical appeal. • Performing tasks within current systems (PAI, Midas, Invision, MS4 Meditech) to ensure documentation of TAR and commercial clinical denials. • Tracking Medicaid/Medi-Cal cases to ensure timely receipt of any concurrent appeal decision by the payer. • Monitoring payer and State portals and websites for documents related to commercial certification, Treatment Authorization Request (TARs), and Service Authorization Request (SARs) • Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Optum360s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and detail oriented behavior. • Other duties as needed and assigned by the Manager.
• Must be proficient in Microsoft Office, including; Word, Excel, and Outlook • Knowledge of Medical Terminology through college level coursework or at least 2 years of on-the-job training • High School Diploma or GED, required
Accountemps matches highly skilled professionals with accounting finance jobs at the best companies on a temporary and temporary-to-hire basis. Our mission is to provide you with a rewarding finance or accounting job that is well matched to your professional skills – helping you to advance in your career. Our experience, combined with the resources of our worldwide network of offices, makes Accountemps a great resource for your career. We offer excellent opportunities to find temporary accounting and finance jobs for all experience levels. From accounting clerks and bookkeepers to accounts payable and staff accountants, we can provide you unparalleled access to exciting career opportunities. But don't take our word for it. Our company has appeared on Fortune® magazine’s list of “World's Most Admired Companies” since 1998, and 9 out of 10 of our customers would recommend our service to a colleague.
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All applicants applying for U.S. job openings must be authorized to work in the United States. Robert Half will consider qualified applicants with criminal histories in a manner consistent with the requirements of the San Francisco Fair Chance Ordinance.
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