Careers

CASE MANAGEMENT - MEDICARE

Strategically manage services for specified patient population. Provide a focus on wellness, prevention, and efficient care through the coordination with patients, their families, and physicians. The education of the patient and his/her family will be incorporated into the care plan after careful assessment of the patient’s knowledge base, home life, and post-acute resources. The Case Manager will play a vital role in the clinical, financial and education of patients and will ensure these aspects are all considered simultaneously throughout the continuum of care. The Case Manager will ensure the patient receives the right services at the right level of care and will assist the patient in navigating their own care at an optimum level.

1. The ability to demonstrate knowledge and effectiveness of Case Management principles in the following health care areas; processes, relationships, management, community resources, service delivery, psychosocial interventions and all other areas of Case Management.
2. Design and develop a process of identifying patients in need of ongoing surveillance, tracking and screening for development of further complication and follow-up in partnership with the health care team.
3. Coordinates with patient, families, and health care teams to develop a mutually agreeable plan of care that meets the needs of the individual patient.
4. Research the healthcare environment for innovative concepts and best practices and develops practical applications for quality improvement.
5. Develop and maintain processed to improve transitions of care, focusing on hospital and ED discharges as well as post acute care facility usage and interactions with specialists.
6. Develop and maintain processes measuring the patient experience, clinical quality measures and utilization management that drive the cost of care.
7. Keep patients well informed by telephone and in writing of activities/case summaries.
8. Demonstrate sensitivity to issues and show pro-active behavior in addressing client and patient needs.
9. Promotes health education and provides literature to patients to enhance understanding of a condition, treatment or procedure.
10. Assist patients in addressing questions to their physician.
11. Coordinate services for the patient population having a health risk or chronic condition to include screening and on-going monitoring.
12. Utilize appropriate community health care resources to maximize patients healthcare outcomes.
13. Maintain confidentiality and adhere to HIPAA requirements.
14. Document clinical information completely, accurately and in a timely manner.
15. Other duties as assigned.

1. Current LVN/LPN or RN license.
2. Experience with Medicare population a strong plus.
3. Must possess a working knowledge of CPT/ICD-10 codes.
4. Two – three years experience of utilization or Case Management preferred.
5. Knowledge of managed care principles regarding legal and regulatory requirements and confidentiality preferred.
6. Must have excellent communications and presentations skills.
7. Demonstrates diplomacy and professionalism when dealing with staff or patients.
8. Knowledge of primary care a plus

COMMERCIAL INSURANCE CLERK

Following up on Commercial claims status and denials. Researching claims to have processed in a timely manner.

1. Taking care of all accounts with Commercial as their primary insurance.
2. Works all above insurance denials. Must decide why a claim was denied, correct it if possible and re-file as soon   as possible. 
3. Answer phone calls from the patients or other departments.
4. File all supplement insurance claims, which involves matching the claims with the Commercial EOB’s and mailing them or filing electronically.

1.  High School graduate or equivalent.
2.  Computer experience.
3.  Must know how to use a CPT book and ICD-10 book. At least 2 - 4 weeks of training is required.
4.  At least one year follow-up experience on claims is desirable.
5.  Knowledge of medical and medical business office terminology. (EOB, RA, EFT, etc.)

RECEPTIONIST

Represents the clinic in a courteous, efficient and professional manner
by answering and making all necessary telephone calls, scheduling
appointments, greeting and assisting patients. 

1. Answers all incoming telephone calls within the department.
2. Makes necessary outgoing calls regarding appointments or calls
requested by the nurse or physician.
3. Records and gives accurate information for messages.
4. Schedules appointments for provider considering
physician preference as to scheduled appointments and allotted
times.
5. Reschedules appointments if physicians are called away on
emergencies.
6. Checks in patients in a courteous and friendly manner.
7. Performs clerical duties such as ordering supplies, sorting and
distributing mail, making copies and assisting drug reps.
8. Sends FAX information as requested.
9. Helps in other areas as needed.

1. High School Graduate or equivalent.
2. Previous reception experience or background preferred.
3. Previous public contact work and telephone work.
4. Background and knowledge of computers.

RECEPTIONIST - CALL CENTER - UROLOGY

LVN/LPN - PRESCOTT - KAYLA HELLUMS, APRN & KAYLA STOCKTON, APRN

Must have current LPN/LVN license.

PEDIATRIC PCMH POPULATION HEALTH COACH

The Pediatric Population Health Coach (PHC) is an integral part of the Patient Center Medical Home (PCMH). Responsible for outreach to patients through various avenues, with the goal of improving population health, reducing healthcare cost and enhancing patient experience. Focusing on the quality metrics to ensure gap closure for the PCMH population. Gap closure helps identify an opportunity to improve the overall health of the patient. The PCH will play a vital role in the clinical, financials & education of patients & will ensure these aspects are all considered simultaneously throughout the continuum of care.

1. Collaborates with clinical staff to coordinate & gather pertinent information from patients to support clinical management of chronic conditions & close quality gaps
2. Promotes health education & provides literature to patients to enhance understanding of a condition, ER utilization or social determinants of health
3. Actively manages a patient panel ensuring care plan completion
4. Increases individual patient engagement, capability, and accountability through regular patient contact
5. Communicating with & obtaining the approval of the patient and/or the parent to arrange appropriate care
6. Assist patients in addressing questions to their physician
7. Demonstrates sensitivity to issues & shows pro-active behavior in addressing client & patient needs
8. Manually &/or electronically documents interventions in designated template/system
9. Demonstrates continued dedication to the field of health coaching through continuing education & pursuit of new certification
10. Usage of Excel
11. Utilize appropriate community health care resources to maximize patient’s healthcare outcomes
12. Maintain confidentiality & adheres to HIPAA requirements
13. Other duties as assigned

1. Current LVN/LPN license preferred or MA with 10 years of experience
2. Experience with pediatric Medicaid population a strong plus
3. Must processes a working knowledge of CPT/ICD codes
4. Two – three years experience of utilization or Case Management preferred
5. Knowledge of managed care principles regarding legal & regulatory requirements & confidentiality preferred
6. Must have excellent communications and presentation skills
7. Demonstrates diplomacy & professionalism when dealing with staff or patients
8. Knowledge of Patient Center Medical Home (PCMH) and Primary Care First (PCF)

LVN/LPN or CMA - BEHAVIORAL MEDICINE - DR. NANCY GRAVES

Must have current license.