Performs care coordination services for assigned recipients who are eligible for home health services (Home Health Visits, PPEC, Personal Care Services and/or Private Duty Nursing Services etc. based on contract requirements). Uses discretion to approve/validate UR or forward to 2. nd. level reviewer. Provides first level utilization review for all inpatient and outpatient services requiring authorization: Prospective Review Urgent/ Non-urgent, C...
Provides courteous and prompt service to all internal and external customers. Research provider questions regarding status of reviews/authorizations. Prioritizes and addresses requests in a professional manner to develop cooperative relationships and to ensure that customer confidentiality is assured. Understands when to escalate a call to a supervisor. Enters all call data for tracking. Initiates outbound calls as necessary to facilities and pro...
Utilizes discretion and independent judgement to create reports utilizing Microsoft SQL Server Reporting Services to meet business needs. Proficient in Microsoft SQL Server as well as reading and writing complex SQL. Create queries to validate and test reports. Assemble and analyze data for business reports, make sure data and calculations are accurate. Maintain, streamline, and automate monthly, quarterly, and annual compliance reporting. Create...
Utilizes discretion and independent judgement to translate functional requirements into technical solutions. Assist with defining development work plans. Design, develop, & deploy application components. . Communicate development status and escalate issues to management. Execute processes to ensure application integrity and availability. May research alternative development methodologies and make recommendations for team improvement. Execute on o...
Responsible for the efficient operations of agency/state specific contracts and clinical operations. Budget management, personnel management (including hiring appropriate numbers of staff to meeting contract quality and time requirements) and performance management of contract deliverables and requirements. Mentor, lead and manage that state’s UM Management Team. Serve as the primary point of contact for the Agency and eQHealth Solutions. Activel...
. Review of all historical clinical documents related to behavioral health treatment. Complete face-to-face interviews/observations of your. Interview family/guardian and other available parties to obtain psychosocial information. Serve as the behavioral health representative on the multi-disciplinary team. Complete behavioral health treatment component of the youth’s Master Treatment Plan developing treatment recommendations, frequencies, durati...
Utilizes discretion and independent judgement to translate functional requirements into technical solutions. Assist with defining development work plans. Design, develop, & deploy application components. . Communicate development status and escalate issues to management. Execute processes to ensure application integrity and availability. May research alternative development methodologies and make recommendations for team improvement. Execute on o...
Proficient in Microsoft SQL Server as well as reading and writing complex SQL. Conduct unit testing and troubleshooting, ensuring data and calculations are accurate. Create queries and reports for AdHoc requests from the Operations Management and Enterprise Services teams. Work within an Agile team and coordinate priorities with the Scrum Master and stake holders. Work with data and application development team to modify existing reports for any ...
Utilizes discretion and independent judgement to identify, create and execute application functional and regression tests and test scenarios for validating requirements and user acceptance criteria. Collaborate with developers and product development teams to create responsive and compelling user scenarios and corner cases. . Develop test data, execute test scripts and analyze results for validity and clarity. Develops, executes and maintains SQL...
Manages daily UR activities to main timeliness. Responsible for staffing and scheduling allocations. Monitors quality of work by all staff. Promotes professional development of staff through educational offerings. Performs annual appraisals of job performance. Serves as resource for operational information. Oversees development of department policies and procedures. Evaluates review criteria and makes recommendations for revisions as needed. Prov...
The MDT Coordinator is primarily responsible for completing phone interviews, home visits, and scheduling and completing multidisciplinary team meetings for an assigned panel of recipients and their families receiving behavior analysis services to maximize the potential of the child and provide them with optimal healthcare services. The position is also responsible for assessing, planning, implementing and evaluating patient’s health care needs. ...
Performs care coordination services for assigned recipients who are eligible for home health services (Home Health Visits, PPEC, Personal Care Services and/or Private Duty Nursing Services etc. based on contract requirements). Uses discretion to approve/validate UR or forward to 2. nd. level reviewer. Provides first level utilization review for all inpatient and outpatient services requiring authorization: Prospective Review Urgent/ Non-urgent, C...
