Care Advocate
Company: Sentara Health
Location: Miami
Posted on: April 17, 2024
|
|
Job Description:
City/State
Doral, FL
Overview
Work Shift
First (Days) (United States of America)
AvMed, a division of Sentara Health Plans in the Florida market, is
hiring a Care Advocate in Miami or Gainesville Florida. This is a
hybrid position, 2 days in office and 3 days remote.
Scope of the Position: The Care Advocate oversees the daily
operations of the Case Management department by developing and
using workflows and procedures that ensure the highest quality
service and performance levels network coordination, authorization
facilitation, claims resolution and administration.
Essential Job Functions:
Manages referrals received by the case management department,
including but not limited to eligibility verification, Coordination
of Benefits issues, Center of Excellence inclusion and building
care enrollment in the medical platform.
Initiates and manages care enrollments in the medical platform.
Runs all program reports, including timely receipt and disbursement
to case management associates.
Manages post-referral program completion, reconciles visit
summaries to visit dates and ensures timely receipt; maintains a
visit summary repository.
Summarizes program results for case management leadership,
including readmissions, referral volume, and open vs closed cases.
1
Serves as liaison between members, physician groups and case
managers.
Performs additional duties and responsibilities as assigned by
management.
Minimum Requirements:
HS Diploma/GED
2 years of administrative experience in a clinical setting
Bilingual in English/Spanish
Knowledge of medical terminology
Knowledge of Medicare benefits
Familiar with Florida regulatory compliance standards
Ability to meet deadlines in a consistent manner; able to manage
multiple deadlines
Knowledge of Utilization Management, Care Coordination
processes
Strong organizational skills; able to multitask and prioritize.
Strong written/documentation and verbal skills-detail oriented
Detail oriented
Preferred Qualifications:
Experience in a call center environment preferred
Microsoft Office
Creating word documents, communicating with team via Outlook,
creating and updates Excel spreadsheets
Decision-Making
Communications and Collaboration
Organizational Skills
Requires strong organization and prioritization
Our Benefits:
As the third-largest employer in Virginia, Sentara Health was named
by Forbes Magazine as one of America's best large employers. We
offer a variety of amenities to our employees, including, but not
limited to:
Medical, Dental, and Vision Insurance
Paid Annual Leave, Sick Leave
Flexible Spending Accounts
Retirement funds with matching contribution
Supplemental insurance policies, including legal, Life Insurance
and AD&D among others
Work Perks program including discounted movie and theme park
tickets among other great deals
Opportunities for further advancement within our organization
Sentara employees strive to make our communities healthier places
to live. We're setting the standard for medical excellence within a
vibrant, creative, and highly productive workplace. For information
about our employee benefits, please visit: Benefits - Sentara
(sentaracareers.com)
Join our team! We are committed to quality healthcare, improving
health every day, and provide the opportunity for training,
development, and growth!
Note: Sentara Healthcare offers employees comprehensive health care
and retirement benefits designed with you and your family's
well-being in mind. Our benefits packages are designed to change
with you by meeting your needs now and anticipating what comes
next. You have a variety of options for medical, dental and vision
insurance, life insurance, disability, and voluntary benefits as
well as Paid Time Off in the form of sick time, vacation time and
paid parental leave. Team Members have the opportunity to earn an
annual flat amount Bonus payment if established system and employee
eligibility criteria is met.
Keywords: Talroo-health Plan, #Indeed, Bilingual/Spanish, Medical
Terminology, Medicare Benefits,
Job Summary
Care Coordination Technician works in a collaborative role with all
members of the professional health care team and with community
service agencies to coordinate care for members to improve health
outcomes. The Care Coordinator Technician has responsibility for
providing direct support to Care Coordination staff and members by
providing telephone triage for all incoming phone calls, data entry
services for clinical, non-clinical information, distributing
reports to staff for follow up, extracting data for on-going and ad
hoc reports and other duties as assigned by LTSS leadership. Makes
routine/scheduled and ad hoc/follow-up calls to members in
compliance with contractual requirements and the member's plan of
care. Assists Care Coordinators in arranging services associated
with member's plan of care.
-2 years of administrative experience in a clinical setting
-Knowledge of medical terminology
-Knowledge of Medicaid and Medicare benefits
-Familiar with Virginia regulatory compliance standards
-Ability to meet deadlines in a consistent manner; able to manage
multiple deadlines
-Knowledge of Utilization Management, Care Coordination
processes
-Strong organizational skills; able to multitask and
prioritize.
-Strong written/documentation and verbal skills-detail oriented
-Detail oriented
-Experience in a call center environment preferred
Qualifications:
HS - High School Grad or Equivalent (Required)
Clinical, Managed Care, Medical Terminology
Skills
Microsoft Excel, Microsoft Office, Microsoft Word
Sentara Healthcare prides itself on the diversity and inclusiveness
of its close to an almost 30,000-member workforce. Diversity,
inclusion, and belonging is a guiding principle of the organization
to ensure its workforce reflects the communities it serves.
Per Clinical Laboratory Improvement Amendments (CLIA), some
clinical environments require proof of education; these regulations
are posted at ecfr.gov for further information. In an effort to
expedite this verification requirement, we encourage you to upload
your diploma or transcript at time of application.
In support of our mission to improve health every day, this is a
tobacco-free environment. Associated topics: aseptic technique,
diet, drug development, histologist, histology, immunology,
pharmacology, pharmacy, physiology, therapy
Keywords: Sentara Health, Miami Lakes , Care Advocate, Other , Miami, Florida
Click
here to apply!
|