MedWatch, LLC

Customer Support

• Accurately service and satisfy customers by responding to customer inquiries.
• Respond to telephone and email inquiries received from members and provider within defined service standards.
• Negotiate with providers to gain acceptance for plans without network agreements and/or out of network providers.
• Assist members with benefits and healthcare questions.
• Document all calls received in system-based call log.
• The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice.

Concierge Customer Service Representative

Manager

• assists the RN Case Manager in performing necessary functions using the case management process
• authorization of services
• review of treatment plans for medical necessity
• ongoing communication with all members of the health care team
• operate under the direct supervision of the RN Case Manager
• review all medical data to update a case management plan
• make contact with the payer office to understand any benefit constraints
• contact medical care providers and equipment vendors to verify medical necessity
• make care arrangements for quality patient care
• negotiate with providers to maximize medical benefits available to the patient
• maintain case in computer system documenting case actions for each patient
• prepare timely reports to the payer to detail all case actions

Case Manager Assistant – LPN

• Manage individual caseload using the case management process
• Authorization of services and review of treatment plans
• Ongoing communication with health care team members
• Assess problems and determine goals for patients
• Maintain accountability for case management plans
• Make care arrangements according to patient needs
• Document case actions and prepare reports to payers
• Negotiate with providers for maximizing medical benefits

Case Manager, RN

• The Disease Manager Assistant will practice within the scope of his/her licensure.
• The Disease Manager Assistant will operate under the direct supervision of the RN Disease Manager and perform Disease Management functions as directed by the Disease Manager, excluding Initial Case Assessments and Formulation of the Initial Care Plan.
• Review all medical data which can be provided to update a Disease Management plan which will incorporate contact with providers, payers, with the patient and with the patient’s primary caregiver.
• Make contact with the payer office to find out and understand any benefit constraints that will have an impact on the plan of action.
• Proceed with contacting medical care providers and with equipment vendors to verify medical necessity of care or equipment that has been ordered.
• Make care arrangements for quality patient care according to the needs of the patient, the physician’s orders and the benefits available.
• Be aware of any alternative treatment possibilities that may allow the patient to reach wellness goal(s).
• Maintain case in computer system documenting case actions for each patient under your Assigned Disease Managers caseload, under direction of the Disease Manager.
• Prepare timely reports to the payer to detail all case actions, the results of those actions, and the continuing Disease Management plan, which are reviewed by the Disease Manager.

Concierge Customer Service Representative

Case Manager Assistant – LPN

Case Manager, RN

Case Manager Assistant – Disease Management, LPN