CommuniCare Health Services

Human Resources

• Support Human Resources operations at 17 facilities
• Facilitate change by anticipating, identifying, planning, and implementing people strategies
• Partner with facilities to achieve human resource goals & objectives
• Deliver employee centric solutions and recruitment strategies
• Work with stakeholders to prioritize work and improve employee experience
• Partner with business groups to understand challenges and implement HR programs
• Coach senior staff members to increase leadership effectiveness
• Ensure timely and accurate data entry, processing, and auditing for assigned facilities
• Travel as necessary to support on-site human resource needs

Regional HR Business Partner

Pharmacist

• Manage real time insurance claims while providing customer service to clients
• Analyze and approve claims that need to be adjudicated
• Determine coverage and apply medical necessity guidelines
• Identify and clarify any discrepancies to complete the adjudication process
• Work in cohesion with the CIC Department, Prior Authorization, and Billing Departments
• Submit claims and add appropriate corrections
• Ensure accurate and timely processing of real time claims
• Work directly with third party payers for claim resolution
• Communicate with facilities on claim issues that will need attention by the facility
• Resolve any discrepancies and secure proper reimbursement
• Any other duties associated with adjudication
• Create Prior Authorizations and notify Authorization team
• Follow federal and state regulations
• Adhere to company policies and procedures
• Follow HIPPA guidelines and regulations

Pharmacy Adjudication Specialist

Medical Director

• Assume the administrative authority, responsibility, and accountability of implementing medical services, policies, and procedures
• Coordinate medical care, including emergency treatment procedures
• Maintain effective liaison with attending physicians
• Implement methods to keep the quality of care under constant surveillance
• Provide necessary physician services for those residents within skilled nursing facilities and/or clinic environment

Administration

• Coordinate with telehealth providers to ensure appropriate patients receive telemedicine services.
• Communicate with onsite nursing teams to ensure all clinical needs are coordinated.
• Oversee provider queue in Never Alone.
• Support technical issues that arise for telehealth provider team.
• Monitor EMR to triage routine clinical lab requests, routine imaging results, notifications, etc. that result after hours.
• Maintain timely documentation of encounters with facility nurses in the EMR.
• Record information directly into CRM system.
• Connect patients that need to be seen acutely by an in-house provider the next day with Central Scheduling.
• Answer and triage calls from Never Alone use cases outside of the SNF use case.
• Provide health education.
• Provide an excellent customer experience to foster high customer satisfaction/retention.
• Practice ethically and in accordance with the Scope and Standards of Practice of their profession and Board Certification.
• Follow all state and federal regulations, guidelines, and laws.
• Collaborate with telehealth provider group.
• Participation in monthly staff meetings.
• During downtime there may be some additional project related work related to the development of protocols, initial quality review of previous encounters, or projects to be defined as the role evolves.

RN Telehealth Administrator, On Call, PRN

Therapist

• Helps clients improve their quality of life by helping them compensate for limitations
• Implements treatment plan through direct treatment and collaboration with Occupational Therapist
• Complies with the documentation requirements of the rehab department and facility under the supervision of an Occupational Therapist
• Opportunity to treat at multiple locations

Certified Occupational Therapy Assistant, COTA

• Assume the administrative authority, responsibility, and accountability of developing and implementing our PM&R program, policies, and procedures
• Coordinate medical care, including emergency treatment procedures
• Maintain effective liaison with attending physicians
• Implement methods to keep the quality of care under constant surveillance
• Provide necessary physician services for those residents in skilled nursing facilities and/or clinic environment

Regional HR Business Partner

Pharmacy Adjudication Specialist

Medical Director

RN Telehealth Administrator, On Call, PRN

Certified Occupational Therapy Assistant, COTA

Medical Director, Physical Medicine and Rehabilitation (PM&R), Physiatry