SLH Care Management Specialist

4 weeks ago

Sunnyvale, United States Alameda Health System Full time

Summary

SUMMARY: Assists in Care Management Team of social workers and nurses with functions such as but not limited to provide census reconciliation, administrative support for care coordination and discharge planning activities, working with the payors, accurate and critical information data entry and tracking, and report creation.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1. Functions as a key point of contact between clinical case management staff, admissions and payors. Documents all interactions with payors and communicates status with Care Management staff.

2. Coordinates and obtains authorizations for admissions; documents all information in the AHS financial system; works closely with Revenue Cycle to ensure each inpatient encounter is accurate; coordinates all reviews and inquires with the payors.

3. Reconciles census; works with Patient Access and the Care management team to ensure census is correct in the financial and care management systems; prepares paperwork and updates encounter information for admissions, discharges and transfers of patients; prepares census for the Care Management staff.

4. Collaborates with Case Management staff to provide specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post discharge services.

5. Per the direction of the Care Management social worker and/or nurse, facilitates, identifies and documents all referrals made to contracted facilities, providers or agencies, makes post discharge appointments for patients and coordinates transportation; expedites discharges by transmitting appropriate documentation to providers for acceptance of patient; documents all interactions with payers and communicates status with appropriate staff.

6. Manages multiple inquiries and presents referral based on location and services provided; appropriate follow up on active or pending inquires.

7. Coordinates with referral sources on bed availability, new product and services; maintains current database of existing and potential referral sources.

8. Communicates status with Care Management staff and arranges for patient transfer; functions as a key point of contact between Care Management staff, admissions and payers.

9. Coordinate and track any communication, e.g. Important Message (IM) letters, Denial Letters, patient choice forms; regularly updates Care Management team.

10. Supports any audits with coordinating medical records with HIM; prepares statements of diagnosis and treatments, and extracts other information required for the completion of forms received from patients' insurance carriers.

11. Perform all other duties as assigned.

MINIMUM QUALIFICATIONS:

Required Education: High School Diploma or G.E.D.

Preferred Education: Bachelor's degree in related field.

Required Experience: Three years in a health care field or one year in Utilization Management at a Medical Group or Health plan experience; electronic Health Record (EHR) and Case Management applications, e.g. Midas or 3M.

Preferred Experience: Medical Assistant.
San Leandro Hospital
SLH Social Services
Services As Needed / Per Diem
Day
Care Management
FTE: 0.01
RequiredPreferredJob Industries
  • Other

  • Services Management Specialist

    1 week ago

    Sunnyvale, United States Juniper Networks Full time

    ENGINEERING- Juniper Networks in Sunnyvale, CA seeks Services Management Specialist: Manage technical cases and work with technical teams to expedite resolution. Manage customer inventory using Excel and Juniper internal tools. Full-time telecommuting allowed. $107,500/ yr. - $132,000/yr. Email res (must reference Job Code #112484) to resumedropbox@...

  • Asset Management Specialist

    1 month ago

    Sunnyvale, United States Wipro Full time

    We are Wipro (NYSE: WIT), a rapidly expanding and leading global Information Technology, Consulting and Business Process Services company with over 225,000 employees worldwide, servicing clients in 175+ cities and 69 countries across 6 continents. For more information, please visit www.wipro.com.Role Overview: The Asset Management and Site Operations...

  • Asset Management Specialist

    4 weeks ago

    Sunnyvale, United States Wipro Full time

    We are Wipro (NYSE: WIT), a rapidly expanding and leading global Information Technology, Consulting and Business Process Services company with over 225,000 employees worldwide, servicing clients in 175+ cities and 69 countries across 6 continents. For more information, please visit www.wipro.com.Role Overview: The Asset Management and Site Operations...

  • Learning Management Systems Specialist

    2 weeks ago

    Sunnyvale, United States Advantis Global Full time

    Sunnyvale - , - California - Skills - Remote Work Option: - Yes- Job ID: - 348272 - Employment Type: - Contract - Pay Rate: - Base Salary: - $ - 63.00 - /hr ABOUT THIS FEATURED OPPORTUNITY THE OPPORTUNITY FOR YOU The role involves collaborating closely with the internal team to assess the feasibility of migrating the SABA Learning Management System...

  • Membership Specialist

    1 month ago

    Sunnyvale, United States UFC GYM Full time

    The Membership Specialist (MS) will represent UFC GYM by providing a welcoming, informative, and entertaining experience for all members and guests during their visits. The Membership Specialist is responsible for driving potential members into the gym to deliver industry leading customer services to them as well as our current members. This service must...

  • Membership Specialist

    4 weeks ago

    Sunnyvale, United States UFC GYM Full time

    The Membership Specialist (MS) will represent UFC GYM by providing a welcoming, informative, and entertaining experience for all members and guests during their visits. The Membership Specialist is responsible for driving potential members into the gym to deliver industry leading customer services to them as well as our current members. This service must...

  • Activity Specialist

    1 week ago

    Sunnyvale, United States Sage Eldercare Solutions Full time

    Job DescriptionJob DescriptionActivity SpecialistJob Location: Santa Clara County, CA; Various South Bay Area, CA locations. Requires on-site work in residences and facilities and remote collaboration with team members.Job Schedule: Part-time to Full-timeReports to: Hummingbird Project ManagerAre you driven by a passion to make a meaningful impact in the...

  • Activity Specialist

    3 weeks ago

    Sunnyvale, United States Sage Eldercare Solutions Full time

    Job DescriptionJob DescriptionActivity SpecialistJob Location: Santa Clara County, CA; Various South Bay Area, CA locations. Requires on-site work in residences and facilities and remote collaboration with team members.Job Schedule: Part-time to Full-timeReports to: Hummingbird Project ManagerAre you driven by a passion to make a meaningful impact in the...

  • Localization Specialist

    1 month ago

    Sunnyvale, United States Cynet Systems Full time

    Job Description: Pay Range $50hr - $60hr Responsibilities: Plan, scope, execute and monitor localization projects by working with the technical writers, information architect, DITA specialist, documentation specialists, eIFU specialist, project managers and external translation vendors Lead kickoff and regular meetings with translation suppliers with...

  • Localization Specialist

    4 weeks ago

    Sunnyvale, United States Cynet Systems Full time

    Job Description: Pay Range $50hr - $60hr Responsibilities: Plan, scope, execute and monitor localization projects by working with the technical writers, information architect, DITA specialist, documentation specialists, eIFU specialist, project managers and external translation vendors Lead kickoff and regular meetings with translation suppliers with...

  • Senior Billing Specialist

    1 month ago

    Sunnyvale, United States Midas Management and Research Full time

    Summary: This position performs complete medical billing and reimbursement functions and is responsible for all aspects of the medical revenue cycle for Remote Patient Monitoring, Chronic care management and Medical Nutrition Therapy services. Minimum Qualifications Bachelor's degree in accounting, health care administration, finance, business, or...

  • Senior Billing Specialist

    4 weeks ago

    Sunnyvale, United States Midas Management and Research Full time

    Summary: This position performs complete medical billing and reimbursement functions and is responsible for all aspects of the medical revenue cycle for Remote Patient Monitoring, Chronic care management and Medical Nutrition Therapy services. Minimum Qualifications Bachelor's degree in accounting, health care administration, finance, business, or...

  • Proposal Specialist II

    1 week ago

    Sunnyvale, United States ACL Digital Full time

    Proposal Specialist II 09 Months Contract Westford, MA 100% remote position. Responsibilities: Program management of partner-facing requests for proposals, requests for information, an invitation to bid, etc. (RFPs, RFI, ITB), i.e., low to high touch RFPs. The Bids & Proposal (B&P) Specialist will work closely with sales, product line marketing, inside...

  • Communications Specialist

    2 weeks ago

    Sunnyvale, United States DGN Technologies Full time

    **Position Title: Communications Specialist** **Location: Sunnyvale, CA** **Role Type: Long term contract (05/20/2024 to 11/19/2024)** **Description** **Primary Function Of Position** **RESPONSIBILITIES** **Essential Duties**: If you exemplify our values and want to be part of a Company that is passionate about providing value for the patients and...

  • Supply Chain program specialist/Program Manager III

    1 month ago

    Sunnyvale, United States Staffingine LLC Full time

    Supply Chain program specialist/Program Manager III Sunnyvale, CA (Hybrid (Hybrid work: Tues-Thurs in the office. Monday & Friday remote) Job description Work Schedule: (Normal PST business hours, Monday - Friday) Top 3 Daily Responsibilities: Manage the CTB and communication of any risk / Observe and mitigate supply risks and shortages. 2nd source...

  • Lead Project Estimator

    2 weeks ago

    Sunnyvale, California, United States Tailored Management Full time

    Document Control AnalystJob ID:Competitive Pay Rate: Location-basedApproved Locations: 100% onsite; Sunnyvale, CADuration: Initial 12-month contract; extensions/conversion based on performanceStart: Targeting May 2024Benefits: Medical, dental, vision, disability + PTO & sick time availableJob Description:The Document Control Analyst will support product...

  • Senior Quality Specialist

    2 weeks ago

    Sunnyvale, United States Kelly Science, Engineering, Technology & Telecom Full time

    Title: Sr. Quality SpecialistLocation: Sunnyvale, CA- 100% onsite Shift: Monday-Friday, standard working hoursPay: $64-$84/hourOverview:The Sr. Quality Specialist is responsible for supporting quality systems activities related to assay development, especially, design control and risk management activities in accordance with FDA and ISO regulations. This...

  • Senior Quality Specialist

    2 weeks ago

    Sunnyvale, United States Kelly Science, Engineering, Technology & Telecom Full time

    Title: Sr. Quality SpecialistLocation: Sunnyvale, CA- 100% onsite Shift: Monday-Friday, standard working hoursPay: $64-$84/hourOverview:The Sr. Quality Specialist is responsible for supporting quality systems activities related to assay development, especially, design control and risk management activities in accordance with FDA and ISO regulations. This...

  • Delivery Specialist

    3 weeks ago

    Sunnyvale, United States O'Reilly Auto Parts Full time

    Compensation Pay Range:$18.70 - $19.99 The actual hourly rate will equal or exceed the required minimum wage applicable to the job location. Additional compensation includes annual, quarterly performance, or premiums may be paid in amounts ranging pe Delivery Specialist, Delivery, Specialist, Vehicle, Store Manager, Automotive, Business Services

  • Assistant Community Manager

    4 weeks ago

    Sunnyvale, United States Hometown America Management. Full time

    Job DescriptionJob DescriptionHometown America is committed to creating and maintaining a workplace in which all team members have an opportunity to participate and contribute to the success of the business and are valued for their skills, experience, and unique perspectives. This commitment is embodied in Company policy and the ways in which we do business...