Benefits Systems Manager - Healthcare manages the implementation and upkeep of benefits system for managed care and provider data. Monitors systems to ensure medical management needs are met. Being a Benefits Systems Manager - Healthcare ensures fee loading and coding is accurate. Requires a bachelor's degree. Additionally, Benefits Systems Manager - Healthcare typically reports to a head of a unit/department. The Benefits Systems Manager - Healthcare manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Benefits Systems Manager - Healthcare typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Seeking RN, LPN, LMSW or MSW to be responsible for health care management and coordination of members to achieve optimal clinical, financial and quality of life outcomes. MUST reside in the state of VIRGINIA. Schedule M-F 8:00am-5:00pm.
Day to Day Responsibilities: Will be responsible for performing case management activities according to the contractual requirements and in alignment with NCQA requirements. This will include potential home visits to complete assessments as well as completion of telephonic assessments, completion of integrated care plans, and conducting interdisciplinary care team meetings. In addition, conducting needed telephonic follow-up, education, and care coordination for assigned members.
Must Have Skills:
• Must have a valid driver’s license and reliable vehicle for field visits
• Excellent communication skills, with an ability to communicate effectively with members with chronic conditions, developmental disabilities, etc.
• Strong technical skills (utilizing multiple programs at the same time) along with competency in Microsoft applications (Outlook, Teams, Excel, etc.)
• Strong organizational and interpersonal skills
Required Years of Experience: One year of experience working directly with individuals who meet the Cardinal Care Priority Population (Medicaid) criteria.
Required Licensure / Education: Must have Bachelor’s degree in a health or human services field, LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW
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