- Location: Valencia, CA
- Sector: All
- Employment type: Permanent
- Date posted: Jun 12, 2017
- Closes: Jul 10, 2017
The Coordinated Care Program Manager is responsible for operational oversight of U.S. HealthWorks (USHW) centralized intake processes and clinical support for our overall Coordinated Care Management (CCM) Program. The CCM program is a consolidated access-line for our Workers' Compensation Payor & Managed Care clientele to gain entry to the full USHW care delivery offerings of Primary and Specialty Care, Therapy Services, and other in development treatment programs. The Coordinated Care Program Manager provides expert clinical, workers' compensation, training, and program guidance to USHW associates and management in the development and daily functions of our business operations.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Assists with the development and revision of content guidelines for Case History documents, case acceptance standards, and other related CCM program requirements.
2. Completes case history summaries for CCM and other cases presented through the centralized call center.
3. Participates as clinical program leader to provide feedback, expertise, and guidance as the program develops.
4. Interacts with case managers, claims adjusters, physicians, and staff to address pertinent issues that may present during the normal course of operations.
5. Oversees and ensures the quality of Case History Summary documents including content and turn-around times.
6. Interacts with center staff, program team, providers on a routine basis to address, expedite and process cases.
7. Assists with placement of complex cases.
8. Communicates case declination decisions to claims adjusters and case managers.
9. Represents firm in client meetings and conference calls providing clinical expertise and feedback.
10. Trains new and existing staff on program guidelines and expectations.
11. Participates in weekly team meetings & leadership committees to address challenges, opportunities, and program development decisions.
12. Performs ongoing reviews and reports on department productivity and case acceptance rates, including a monthly retrospective review of program metrics and lost opportunities.
13. Performs regular quality assurance reviews of department intake, referral acceptance, and scheduling/placement processes.
14. Performs other duties as assigned.
KNOWLEDGE, SKILLS, AND ABILITIES
1. Knowledge of healthcare industry, including Worker's Compensation, and Managed Care.
2. PC experience to include data entry; Microsoft Excel, Microsoft Word, PowerPoint, as well as automated database management systems.
3. Ability to exercise initiative, independent judgment, responds to multiple requests and works to meet deadlines.
4. Possesses good interpersonal skills, establishing rapport and working well with others.
5. Strong organizational, analytical and problem-solving skills required.
6. Strong customer service and administrative skills required.
Bachelor's degree from an accredited college or university required or equivalent required.
With a minimum of Five (5) years to Ten (10) years' experience in Workers' Compensation Managed Care environment.
Designation of RN, LVN and/or CWCP, preferred