CommuniCare Health Services

Therapist

• Provide psychotherapy, group therapy, and collaborative care management to residents in need.
• Deliver individual and group psychotherapy sessions tailored to the needs of residents.
• Facilitate collaborative care management by coordinating with psychiatrists, primary care providers, and other team members.
• Address the mental health needs of residents with chronic severe mental illness, substance use disorders, depression, and major neurocognitive disorders.
• Develop and implement therapeutic interventions using evidence-based modalities.
• Maintain detailed and accurate clinical documentation in an electronic medical records (EMR) system.

Therapist, Behavioral Health Care Manager (LSW, LISW)

Manager

• Oversee and coordinate the care of assigned ISNP members, ensuring they receive timely and appropriate care as dictated by the SNP Model of Care.
• Perform initial, annual, transition of care (TOC) and change in condition health risk assessments (HRA) for ISNP care managed caseload.
• Formulate and implement a member centric holistic care plan that addresses identified needs by assessing the member/representative/family needs, issues, resources and care goals; determining and educating on the choices available to the individual member.
• Collaborate with the interdisciplinary team (ICT) which may include Medical Director, PCP, nurse practitioners/physician assistants, pharmacy, dietary, social workers, other clinical and non-clinical disciplines, facility staff, member representatives and family to establish, revise and continuously evaluate the member centric care plan.

Health Plan Care Manager, RN/LSW

Sales

• Responsible to work collaboratively with Regional Director of Operations (RDO) to exceed budgeted census and achieve optimal quality mix
• Must work to establish CommuniCare as provider of choice in the markets they represent
• Development and execution of marketing plans and programs, both short and long term, to support sales and revenue objectives of organization
• Ensures effective management of marketing and sales results, and takes corrective action to guarantee that achievement
• Oversees coaching and development of the sales staff with direct supervision of hospital and clinical liaisons
• Establishes and maintains relationships with industry influencers and key community partners
• Prospecting to gain and secure access to higher level hospital/ACO/Physician/C Suite relationships
• Assists with Development and manages the marketing operating budget in cooperation with operations
• Identify, communicate, advocate, and when appropriate, intervene with obstacles to optimum census outside of admissions, sales, and marketing (i.e. operational, clerical, and administrative issues)
• Guides preparation of marketing activity reports and presents to executive management

Regional Sales Manager

Billing Specialist

• Completing Action Summary for assigned homes on a daily basis
• Census reconciliation on a weekly basis including Medicare
• Verifying correct patient setup for monthly billing
• Completing SQL Reports
• Monitor and manage room moves and update in Framework
• Begins rebill process based on payer changes
• Primary Billing Batches worked in timely manner
• Primary and Secondary Rebilling - Private Pay accounts, Medicaid approval, incorrect billing
• Communicate to management if Rebilling is not completed by the 9th of each month
• Back up for daily deposit
• Back up for Hospice Med list and hospice rebilling
• Ensure assigned homes billed accurately and timely at month end
• Assist Accounts Receivable Analyst in customer notes and billing questions
• Monitor Medicaid Pending Group each month
• Send BAE on Medicaid Approved Residents when needed
• Third Party Audits as requested by supervisor
• Assist with Training and QA

Pharmacy Billing Specialist

Claims Specialist

• Manage the insurance claims process
• Provide customer service to clients
• Analyze and approve claims that cannot be adjudicated
• Determine coverage and applies medical necessity guidelines
• Identify and clarify any discrepancies to assist in the adjudication process
• Ensure accurate and timely processing of rejected claims
• Work directly with third party payers for claim resolution
• Communicate with facilities on claim issues
• Resolve discrepancies and secure proper reimbursement
• Follow federal and state regulations
• Adhere to company policies and procedures
• Follow HIPPA guidelines and regulations

Pharmacy Claims Specialist

Procurement

• Oversee the procurement of medications, medical supplies, and pharmacy equipment
• Negotiate contracts and agreements with suppliers
• Manage inventory levels, ensuring availability while minimizing excess stock
• Implement inventory management systems
• Ensure compliance with federal and state regulations
• Supervise and train purchasing staff
• Work closely with pharmacy management, clinical staff, and other departments

Pharmacy Purchasing Manager

• Deliver individual and group psychotherapy sessions tailored to the needs of residents.
• Facilitate collaborative care management by coordinating with psychiatrists, primary care providers, and other team members.
• Address the mental health needs of residents with chronic severe mental illness, substance use disorders, depression, and major neurocognitive disorders.
• Develop and implement therapeutic interventions using evidence-based modalities.
• Maintain detailed and accurate clinical documentation in an electronic medical records (EMR) system.

Therapist, Behavioral Health Care Manager – LPC, LPCC, LSW, LISW

Medical Director

• Assume the administrative authority, responsibility, and accountability of implementing our medical services, policies, and procedures according to federal, state and local regulations; and current practice of post-acute and long-term care medicine.
• Coordinate medical care, including emergency treatment procedures, maintain effective liaison with attending physicians, and implement methods to keep the quality of care under constant surveillance.
• Provide necessary physician services for those residents within the skilled nursing facilities and/or clinic environment

• Perform patient’s/resident’s occupational needs evaluation under physician order and develop a treatment plan in accordance with patient’s needs.
• Implement treatment plan through direct treatment, as well as education of treatment staff including therapists and other members of team involved in treatment plan.
• Provide necessary supervision for COTAs.
• Attend/Lead interdisciplinary meetings as appropriate to relay clinical findings and make recommendations to other members of rehab team, including family education and consultation.
• Opportunity to treat at multiple locations, allowing you to serve the diverse needs of residents.

Occupational Therapist, OT

• Develop the strategic marketing plan to support the membership targets established by the CommuniCare Family of Companies leadership for its Institutional Special Needs Plan (I-SNP) and Chronic Condition Special Needs Plan (C-SNP) Medicare Advantage products including:
• Collaboration with the VP of Marketing for CFC regarding the campaigns, methods and collaterals to be used in the sales process to ensure a seamless branding with other CFC products and services
• Developing recommendations regarding proposed, advertising campaigns including media buys, collateral development, messaging, and other features.
• Providing competitive intelligence regarding I-SNP and C-SNP product attributes in the target markets in Indiana, Ohio and Maryland.
• Providing C-SNP specific approaches including community-based marketing strategies to leverage existing resources and relationships of the CommuniCare Family of Companies (CFC) to extent allowed through the Centers for Medicare and Medicaid (CMS) marketing guidelines.
• Developing successful sales strategies to optimize sales environments in which face to face engagement may be limited.
• Developing purchase or use agreements among the CFC companies to obtain beneficiary data available to entities within CFC to creating mailing and outreach lists within the limits established by CMS, HIPAA, and other regulatory agencies.
• Developing compliant procedures, documentation and workflows in collaboration with applicable CFC entities and CommuniCare Advantage or CFC vendors to optimize CFC relationships in the sales process.
• Developing an annual marketing and sales calendar for the CommuniCare Advantage Special Needs Plans, and/or other products as applicable, to aid in strategy development and resource planning across the CFC enterprise.
• Developing, reviewing, and refining draft Evidences of Coverage, Enrollment Forms, and/or other member collaterals required for submittal to CMS for approval for use during the open enrollment period and throughout the applicable contract year.
• Supporting the annual MOC and application development, PBP and bid submittal and other CMS required processes during the year.
• Developing a customer relationship management approach leveraging existing infrastructure and tools or through identification and engagement of additional tools in collaboration and with the approval of the VP of Business Integration and Solutions, to track outreach attempts, “no thank you,” “do not contact,” and other requests to maintain a highly ethical and compliant sales organization.
• Develop staffing and training strategy necessary to implement and successfully execute the marketing plan and meet or exceed the membership targets including:
• Development of staffing levels and staff qualifications and deployment
• Developing compensation schedule recommendations including base salary and commission or bonus structure for various levels of staff.
• Develop and execute a recruitment strategy to ensure that qualified, licensed, and professional sales force is on boarded across the three target markets to meet emerging CMS requirements.
• Developing training materials that both comply with the CMS requirements and the business needs of the Company to address compliance, cultural competency, Models of Care, and specific product details and company culture.
• Collaborate with the Compliance Officer to establish training, audit and response procedures related to marketing-related activities and grievances.

Director – Sales and Marketing, Medicare Advantage Plans

Administrative Assistant

• Complete weekly BOM Admission Checklist and present weekly at morning stand up to reduce exceptions
• Verify and tie out the midnight census testing for validity and accuracy on a daily basis
• Reference Policy Midnight Census
• Complete admission procedures in absence of Admissions Coordinator
• Conduct weekly Medicaid pending/collection blitz meeting with facility staff
• Reference Policies Collection Blitz and Medicaid Pending Log and Meetings
• Complete root cause analysis on accounts that contribute to bad debt then advise Executive Director regarding types of issues identified and proposed solutions
• Complete insurance forms per request
• Attend Utilization Review (UR) and/or PPS meeting as necessary
• Supervise, organize, evaluate, and monitor all business office support staff
• Meet with resident/responsible parties upon admission and discharge to discuss financial obligations
• Complete and coordinate tasks necessary for timely and accurate billing and collection
• Attend and participate in scheduled training, education classes, and orientation programs to maintain and enhance quality of care
• Maintain and work within established departmental, center, and home office policies and procedures, objectives, quality improvement program, and safety, environmental, and infection control standards