Medical Management Director jobs in Winston Salem, NC

Join us at PRISM for an exciting new career opportunity!

Caring Team Environment where YOU matter

If youre looking for a career that

• Satisfies your interest in the medical field with values centered around patient care
• Gives you a stable, Monday through Friday schedule
• Provides unmatched training so you are confident in your ability to help others
• Offers opportunities to help patients and make a difference in other lives everyday

then PRISM is the right match for you!

We offer you:

• A competitive salary
• 3 Weeks of Paid Time Off that begins accruing your first month of employment!
• Paid Holidays - eligible upon hire!
• A comprehensive list of health benefits options to choose from
• Employer match to 401k contributions
• Robust training programs on professional, technical and leadership skills
• Employee Referral Program
• Education Reimbursement
• Community outreach opportunities
• and more!

Founded in 2006 and headquartered in Elkin, North Carolina, PRISM is a nationwide provider of specialty home medical supplies with a core competency in advanced wound care products. Most recently, Henry Schein, Inc. the worlds largest provider of health care solutions to office-based dental and medical practitioners, announced the acquisition of a majority ownership position in Prism Medical Products, LLC (PRISM). PRISM serves a broad and loyal referral network of nationally affiliated and independently operated wound care clinics, as well as specialist practices and clinics in primary care, ostomy, podiatry, rehabilitation and physical therapy, general and plastic surgery, dermatology, and vascular medicine. PRISM enjoys strong referral retention rates as well as high marks for customer satisfaction.

We continue to be a fast-growing home medical supply company that serves our community. Consistently delivering our special recipe of quality and reliable service for all patients, medical facilities, and vendors has made us a unique presence nationwide. We are a valued and trusted health care partner.

A day in the life of a Care Management Associate Coordinator:

• Pursues industry knowledge for Medicare, Medicaid, and Commercial payers as it pertains to PRISM core lines of business and how we can generate referrals and contracts, exhausting all opportunities to service out of network patient referrals to include, but limited to, gap exceptions, LOA, TPAs, and e-commerce.
• Functions as an Account Management Liaison and partners with Payer Relations Contracting Administrator to identify out-of-network payers and capturing clinician and patient referral letters for target health plans in pursuit of contracts.
• Maintains KPIs for reporting, Quarterly/Monthly, to promote ongoing review of the necessary benchmarks for optimal sales or administration of health plan benefits and communicates trends and problem solves.
• Monitors the performance of departmental projects including leads and/or project contributors, tracking and providing progress updates to leadership at regular intervals.
• Pursues industry knowledge for Medicare, Medicaid, and Commercial payers as it pertains to PRISM core lines of business and how we can generate referrals and contracts.
• Continually contributes to the creation and maintenance of private insurance contact cards and promotes high utilization within Billing, Client Operations, Quality Assurance, and Payer Relations.
• Participates in the Certified Training Assistant (CTA) program as a CTA, and successfully completes available leadership development programs to actively mentor PRISM team members company-wide about private insurance and support Training & Development.
• Drives departmental and interdepartmental meetings e.g., Client Operations to facilitate and capitalize off strategic alliances, open communication, problem solving and collaboration referral relationships and subsequent payment of claims to advance Prism?s effectiveness to successfully grow referral sources and community outreach by cultivating positive relationships throughout the organization.
• Executes effective management of administrative budgetary items, and the scheduling, disciplinary action, performance evaluation, and paid time off for assigned team members.
• Organizes monthly/quarterly meetings, in-services, education, and training to address and resolve gaps in knowledge, or other issues regarding health plan protocols, procedures, processes, and overall effectiveness of referral sources.
• Develops team members and implements protocols to enhance the department?s ability to be effective and efficient in delivering the highest level of care for our out of network patient referrals from health plans, facilities, and through our e-commerce platform; and troubleshoots all issues to provide resolutions in a timely manner.
• Seeks out and promotes extensive knowledge of product offerings and avenues to offer products to the patient that is compliant to our regulatory standards.
• Maintains an excellent attendance record and drives excellent attendance of departmental team members through accountability measures and incentives.
• Adheres to all company policies and procedures regarding employment, safety and compliance and report any concerns of non-compliance in any area to your manager immediately.
• Performs other related duties as requested and assigned by Leadership.

Why members of #teamPRISM enjoy working here:

Prism has a close-knit culture where everyone knows your name and youre not just a number.

Its a great family environment and each part of the company works together for the greater good of the patients.

Prism is the best company I have ever worked for. I love it here because there are so many growth and development options for me.

I learn something new every day and I love the excellent values the company stands behind and upholds to patients and clients every day. BEST PLACE TO WORK!

Find your career home! Apply today!