Financial Clearance Specialist 1
Savista
Care Manager, RN – Transplant
Centene Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States • Arizona
Visit company websiteSalary
💰 $55,100 - $99,000 per year
Job Level
JuniorMid-Level
About the role
- Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes
- Manage patient care plan and provide oversight for transplant processes and large dollar cases
- Coordinate transplant requests from pre-approval to claims payment processes and assist with approved transplant center process within contractual timeframes
- Ongoing communication with transplant facility, assigned case manager, medical director and finance to ensure materials are gathered for financial processing
- Analyze and review transplant contract and claims and liaison with transplant contractor for approval and claim pricing
- Maintain transplant and catastrophic case logs and perform related medical management and finance reporting
- Ensure proper processing of high dollar transplant claims
- Provide resource support to members and care managers for local resources (e.g., employment, housing, participant direction, independent living, justice, foster care)
- Facilitate care management and collaborate with appropriate providers or specialists to ensure timely access to needed care or services
- Perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
- Collects, documents, and maintains all member information and care management activities to ensure compliance with regulators
- Provide and/or facilitate education to members and their families/caregivers on disease processes, resolving care gaps, care options, referrals, and healthcare benefits
- Provide feedback to leadership on opportunities to improve and enhance care and quality delivery
- Perform other duties as assigned by people leader to meet business needs
Requirements
- Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing
- 2 – 4 years of related experience
- RN - Registered Nurse - AZ State Licensure and/or Compact State Licensure required
- Candidates must live in AZ
- Ability to collect, document, and maintain all member information and care management activities to ensure compliance with state, federal, and third-party payer regulators
- Ability to perform telephonic, digital, home and/or other site outreach to assess member needs
- Must comply with all policies and standards
