6 Purchased Referred Care Case Manager Jobs in Albuquerque, NM
SORT BY
S
T
A
I
S
C
Purchased Referred Care Case Manager
$49k-60k (estimate)
Full Time | Consumer Services
9 Months Ago
Sorry! This job is no longer available. Please explore similar jobs listed on the left.
Sandia Resort And Casino is Hiring a Purchased Referred Care Case Manager Near Albuquerque, NM
Position Summary
Provides case management, support and technical assistance to patients seeking Purchased/Referred Care (PRC). This position plans, implements, coordinates and monitors all purchased/referred care within the Pueblo of Sandia.
Supervision Exercised
Reports to the Health Center Business Manager.
Major Duties and Responsibilities
- Provides lead support to the front-end of the PRC office patient referral process.
- Records and organizes patient and referral information for review by Health Center Director for determination.
- Verifies eligibility for Sandia PRC services with consideration of factors including, but not limited to, tribal descendent status, patient age, place of residence, availability of alternative resources and student status.
- Ensures services are prioritized appropriately as P1 Emergency, P2A Routine/Chronic and P2B Screening.
- Identifies alternate medical resources available to patients, including but not limited to Medicare, Medicaid, Veterans Administration, Workers Compensation and Patient Assistance Medication Coverage. Prepares additional liability forms as necessary.
- Coordinates appointments with outside contract provider services or IHS facility and patient including proper documentation and transportation when applicable. Completes and tracks all necessary information in system as appropriate for services.
- Maintains consistent communication with internal and external staff to ensure appropriate case monitoring and management practices are in place for continuous continuity of care through completion of PRC services.
- Verifies accuracy of incoming charges associated with an approved referral. Completes Purchase Order (PO) request in system in a timely manner for processing of payment through IHS/PRC Fiscal Intermediary.
- Resolves outstanding open approved referrals and open PO issues in a timely manner.
- Negotiates new and maintains existing outside provider contracts in conjunction with the IHS/PRC Fiscal Intermediary as necessary.
- Assists in gathering information for the preparation and submission of Catastrophic Health Emergency Fund (CHEF) applications.
- Maintains the privacy and confidentiality of patient information in accordance to the Privacy Act, Health Insurance Portability and Accountability Act (HIPAA), Electronic Health Record (EHR) system policies and procedures.
- Performs special projects and other related duties as assigned
Secondary Duties and Responsibilities
Backup support when Benefits Coordinator is unavailable.
Knowledge, Skills and Abilities
- Intermediate knowledge of medical terminology preferred. Knowledge of PRC regulations, policies and procedures, third party billing standards policies and procedures to operate the program effectively and efficiently. Intermediate knowledge of computer programs and use.
- Knowledge of Medicare, Medicaid, Workers Compensation and other health care resources preferred.
- Strong ability to communicate with tact and diplomacy with diverse groups of people.
- Strong ability to work on a variety of assignments/issues concurrently within established deadlines.
- Strong attention to detail with ability to function effectively with frequent interruptions.
- Strong ability to work and communicate effectively and cooperatively in a service environment, including extensive telephone communication.
- Strong ability to protect confidential information.
Minimum Qualifications, Education and Experience
Required:
- High School Diploma, GED certification or equivalent
- Intermediate knowledge of RCIS (Referral Care Information System) computer program and skill in recording and organizing patient referral care information.
- The following license and/or certifications are required prior to employment start date:
- CPR certification
Preferred:
- Three (3) years of experience in a relevant office or health care setting
Licensing Status
- Must be able to successfully pass a stringent background and character investigation in compliance with PL 101.630
- Will require a post-offer, pre-employment and random drug screening.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Consumer Services
SALARY
$49k-60k (estimate)
POST DATE
09/01/2023
EXPIRATION DATE
05/22/2024
WEBSITE
sandiacasino.com
HEADQUARTERS
ALBUQUERQUE, NM
SIZE
100 - 200
FOUNDED
1994
TYPE
Private
CEO
ALFREDO HERNANDEZ
REVENUE
$10M - $50M
INDUSTRY
Consumer Services
Related Companies
About Sandia Resort And Casino
Sandia Resort & Casino offers accommodation, dining and spa services.
Show more
Similar Jobs
Popular Articles
Top 10 Things to Avoid Putting on a Job Application
Read Article
How to Describe Your Education in a Resume
Read Article
How to Write a Memorable Cover Letter in 5 Ways
Read Article
4 Personal Finance Tips to Make During Job Transition
Read Article
4 Best Camera Setups for Interview
Read Article
Keeping a Job Search Journal: 9 Types of Journaling You Can Do
Read Article
