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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Support all aspects of the Care Management (CM) compliance program for the Dual Special Needs Program (DSNP). Assume the primary role of interfacing with the Compliance department, Auditors, Vendors and Health Service (HS) staff for purposes of monitoring and ensuring compliant operations for the DNSP Program.
Essential Responsibilities :
Maintaining compliant member, CM, and provider communications. Keeping letters and other member communications up to date with DNSP compliance guidance and best practices.
Supporting Responsibilities :
SUCCESS PROFILE
Work Experience : Minimum of four years of CM related health insurance experience required. Strong preference for experience in auditing or compliance related role.
Experience in using multiple data reporting and analytic platforms preferred. Strong knowledge base in understanding and applying Medicare and Medicare requirements preferred.
Experience and training in Quality Improvement methodology preferred (PDSA, LEAN).
Education, Certificates, Licenses : High school diploma or equivalent required. Bachelor's or Associates degree preferred.
Knowledge : Strong computer skills. Excellent verbal and business writing skills. Excellent public relations skills. Good understanding of Medical Terminology and Regulatory language required.
Ability to comprehend and apply regulatory language and develop action plans to assure compliance. Requires ability to define and prioritize problems and manage workload without direct supervision.
Competencies
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Conflict Management
Contributing to Team Success
Negotiation Skills
Planning and Organizing
Problem Solving
Quality Improvement
Work Standards
Environment : Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 15% of the time.
Skills :
Accountability, Collaboration, Communication (written / verbal), Flexibility
Group Problem Solving, Listening (active), Organizational skills / Planning and Organization, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :
Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.
Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change.
It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.
Employment remains AT-WILL at all times.
Last updated : 2024-05-22
Full Time
$66k-84k (estimate)
05/23/2024
08/22/2024