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Patient Advocacy Case Manager

Company: Prime Health Services Inc.
Location: Franklin
Posted on: May 3, 2021

Job Description:

Prime Health Services (PHS) is a national medical cost containment company with a noteworthy PPO Network used by insurance carriers, TPA''s, self-insureds, and governmental entities. Our tech-focused nature allows clients to take advantage of the flexibility of customization while not compromising on bill processing speed. Since 2001, we have specialized in medical provider network development and offer clients a tailored approach to medical cost containment: quality health care at discounted rates. The Patient Advocacy Case Manager position reports to the Director of Patient Advocacy and works collaboratively with PHS''s Clients and referred patients to ensure timely scheduling of patient appointments consistent with their requests and defined treatment plan. This position refers cases, where in-network Providers are not available in the desired geographic area, to the Negotiator and/or Provider Contracting Specialist to secure a single case agreement with an appropriate Provider. With a primary focus to facilitate the patient''s recovery, this position must demonstrate excellent communication, documentation, and follow-up skills throughout the management of each assigned case. Essential Job Functions Provides Medical Case Management to individuals through telephonic communications with the patient, physician, other health care providers, and others Proactively manages all active cases to assess progress/response to treatment, prevent lapses or delays in treatment, obtain regular updates and facilitates patient''s recovery plan Schedules medical appointments via the PHS scheduling tool as requested and directed by PHS Clients and the referred patients in a timely manner Updates Client regarding status when patient expenses are nearing the maximum allotment to receive direction as to next steps, i.e. increase allotted dollar amount assigned to the case or close the case Refers out-of-network providers to the Negotiator to obtain a single case agreement and to Network Development to contract the provider to the PHS network This position is an in office position at PHS'' corporate office Bachelor''s Degree or Registered Nurse (RN) license in good standing URAC-recognized certification in case management within four (4) years of hire as a case manager Pursue URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN) upon eligibility A cost containment background, such as utilization review or managed care is preferred Bilingual in Spanish/English is helpful Demonstrated proficiency in Microsoft Office - Excel, PowerPoint, Word, MSTeams Competencies Detail focused and the ability to multi-task and adhere to established goals Ability to work in a fast paced, changing environment; flexible to meet business needs Results driven team player Ability to maintain confidential information as required Excellent communication skills (oral and written) Superb organizational, problem solving, and time management skills Ability to maintain a calm and professional demeanor in stressful situations PM21PIby Jobble

Keywords: Prime Health Services Inc., Franklin , Patient Advocacy Case Manager, Other , Franklin, Tennessee

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