Sabtu, 01 Oktober 2016

Utilization Management Specialist - Health Plan - Children's Health - Dallas, TX

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Utilization Management Specialist - Health Plan - Children's Health - Dallas, TX -
Description:
Place Abstract
Help and coordinate utilization management actions as they relate to discharge, monitoring and coordination of day by day census. Manage, assess and compile New Welcome regulatory evaluation packets. Guarantee assessments are applicable and up to date. Coordinate new member info with the enrollment division. Coordinate and monitor placements for MDCP, PDN, ECI and different required state packages.
Important Duties and Obligations
Arrange and confirm database reliability for day by day census and rounds agenda
Manage month-to-month minutes from the day by day census and rounds conferences
Help on tasks and time delicate assignments as a result of regulatory turnaround necessities
Collect and arrange knowledge associated to limitations for discharge planning and different utilization outliers
Develop relationships with long run care amenities to assist members
Comply with up with particular discharge wants
Qualifications
Schooling
Highschool diploma or equal, required
4-yr Bachelor’s diploma or equal expertise, most popular
Expertise
1+ yr in a Managed Care setting, required
CPT and ICD 9/10 coding expertise, required
Medicare/Medicaid expertise, most popular
Particular information, expertise and skills
Keep effectiveness when experiencing main modifications in work obligations or setting; regulate successfully to work inside new work buildings, processes, necessities, or cultures.
Use applicable interpersonal types to determine efficient relationships with clients and inner companions; work together with others in a means that promotes openness and belief and provides them confidence in a single’s intentions.
Make sure that the client perspective is a driving drive behind enterprise selections and actions; craft and implement service practices that meet clients’ and personal group’s wants.
Develop and use collaborative relationships to facilitate the accomplishment of labor objectives.
Determine and perceive points, issues, and alternatives; examine knowledge from totally different sources to attract conclusions; use efficient approaches for selecting a plan of action or creating applicable options; take motion that’s in line with obtainable details, constraints, and possible penalties.
Take immediate motion to perform aims; take motion to realize objectives past what’s required; be proactive.
Deal successfully with others in an antagonistic state of affairs; use applicable interpersonal types and strategies to scale back rigidity or battle between two or extra individuals.
Successfully handle one’s time and assets to make sure that work is accomplished effectively.
Accomplish duties by contemplating all areas concerned, regardless of how small; displaying concern for all features of the job; precisely checking processes and duties; being watchful over a time period.
Set excessive requirements of efficiency for self and others; assume duty and accountability for efficiently finishing assignments or duties; self impose requirements of excellence fairly than having requirements imposed.
Assimilate and apply new job-associated info in a well timed method.
Clearly convey info and concepts via quite a lot of media to people or teams in a fashion that engages the viewers and helps them perceive and retain the message.
Bodily calls for
Duties require little or no exertion of bodily effort.


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