Field Case Manager (Part Time)
Location: Grand Island Nebraska
Description: Coventry Workers Comp Services is at present looking to employ Field Case Manager (Part Time) right now, this career will be placed in Nebraska. More complete informations about this career opportunity kindly read the description below. Grand Island, NE
Coventry Health Care was established in 1986 as a provider of managed health care services, offering members a wide choice of op! tions, high standards of care and affordable rates.
FCM - Grand Island, NE , must be bi lingual Spanish, part time
GENERAL SUMMARY:
Responsible for reviewing and analyzing information to make medical determinations based on established criteria, policies, and guidelines. Applies clinical knowledge to assess the level of services for retrospective claims review.
ESSENTIAL RESPONSIBILITIES:
Under general direction, conducts medical reviews of individual provider and hospital claims for coding and billing accuracy, authorization discrepancies, and medical appropriateness for all products in support of company medical payment criteria, policies, and guidelines and according to state law within the state where the claim originated.
Processes and/or reviews claims for compliance and level of care in a timely manner that meets or exceeds production and quality goals. Reviews physician, facility, and specialty claims and adjustments t! o ensure compliance with established company policies and proc! edures.
Consults with management as required for assistance with questions and complex issues that may arise.
Assesses and investigates information to respond to and resolve inquiries including, but not limited to authorizations, payments, denials, and coordination of benefits.
Interfaces with clients by telephone, in writing, and/or in person to answer questions and resolve process issues.
May identify training needs within the team. May train service teams based on outcomes of medical reviews as well as process and/or procedure changes.
Identifies and recommends opportunities for cost savings and improving outcomes.
Performs other duties as required.
JOB SPECIFICATIONS:
Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) with active state license in the state where work is performed required.
Previous experience in Case Management, Utilization Review, Hospital Discharge and/ or DME scheduling preferred.
Pre! vious (3-5 years) clinical experience required.
Knowledge of medical terminology and ICD-9, CPT-4, and HCPCS coding.
Experience in claims review, workers compensation, orthopedics, coordination of benefits, and/or health care products preferred.
May require knowledge and expertise in multi-state laws.
Strong analytical and problem solving skills.
Excellent organizational, interpersonal, and communication skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team
Contact:
Anne Biggs
Regional Recruiter
Coventry Workers' Comp Services
www.cvty.com
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Coventry Workers Comp Services.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Thu, 05 Sep 2013 07:23:08 GMT