Allegiance Benefit Plan Mgmt.
  • 07-Jan-2016 to 31-Mar-2017 (MST)
  • MT, USA
  • Full Time

REPORTS TO: StarPoint Manager LOCATION: Missoula FSLA STATUS: Hourly

POSITION RESPONSIBILITIES:
This position assists with the evaluation medical care alternatives for cases of illness, injuries or medical/surgical diagnoses that require extensive services. These cases may require acute rehabilitation, in-patient hospitalization, or preventive care in an attempt to avoid future complications or admissions. This role serves as clinical coordinator to staff that are performing medical/surgical/ behavioral health reviews. The roll will also serve as a support when screening for case management services and may be responsible for the liaison to steering to disease management programs.


ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.


• Responsible for the effective and sufficient support of all utilization & case management activities.
• Able to initiate phone calls requesting information for admissions and continued stay reviews.
• Uses established set criteria, evaluates and authorizes the medical necessity of some inpatient and outpatient services Criteria includes but, is not limited to:
American Society of Addiction Medicine (ASAM)
MCG
• Able to effectively initiate and return telephone messages independently, as evidence by individual compliance with Quality Assurance (QA) requirements.
• Able to initiate phone calls requesting information for admissions and continued stay reviews.
• Provide accurate information to callers as evidenced by software entry/documentation.
• Compliance with protocols and QA requirements.
• Able to function as training preceptor as evidenced by completion of trainee checklist.
• Participates in team meetings, committees, or committee assignments as evidenced by:
Completion of tasks assigned by team or committee.
Completion of team QA evaluation in compliance with QA protocol; and
Knowledge to present and participate in provider/subscriber and group services, workshops, and educational seminars.
• Participate in the development, screening, and execution of the disease management program as assigned
• Serve as back up for running daily reports for the Office Manager when absent.
• Review letters on a daily basis
• Manage the processing of temporary provider
• Performs other duties and job functions as assigned.


NON-ESSENTIAL JOB FUNCTIONS:
• Preparation of forms, faxing, copying.
• Organizion of files and referance materials.
• Ability to operate typical office equiptment and working knowledge of basic office practices.

PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting: 80% Reaching: Minimal
Standing: 10% Manual Dexterity: Ability to type/keyboard
Walking: 10% Telephone: High Degree
Kneeling: As needed Computer Screen: High Degree
Bending: As needed Lifting: 25 pounds


JOB SPECIFICATIONS:
To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Licensure:

Current licensure as a Licensed Practical Nurse LPN or Licensed Vocational Nurse LVN.
At least one year experience

Other Experience:

Must possess organizational skills and the ability to prioritize multiple tasks, attend to detail and follow through to completion.

 

*Allegiance Benefit Plan Management is an Equal Opportunity Employer.

Allegiance Benefit Plan Mgmt.
  • Apply Now

  • Start Application Through LinkedIn
  • * Fields Are Required
    About You:
    Contact Info:
    Address:

    By clicking the button above, I agree to ApplicantPro's Applicant Information Use Policy.

  • Sign Up For Job Alerts!

  • Share this Page
  • Facebook Twitter LinkedIn Email
.
Logo About Contact Us News Careers