Position Summary:
The Administrative Assistant receives and routes incoming calls, greets visitors, maintains visitor log & badges and provides general information and assistance to the public. This key individual receives incoming mail and assists in preparation and distribution of company materials. The Administrative Assistant performs routine office support functions, including word processing and filing. This employee is not responsible for conducting any UM review activities that require interpretation of clinical information.
Essential Functions:
Performs administrative and office support activities for multiple supervisors, such data entry, word processing, creating spreadsheets, reports and presentations, and/or filing. Receives and screens all incoming calls and channels calls to the appropriate personnel. Greets internal and external clients promptly, while maintaining visitor log and badge preparation. Provides general information and guidance to callers and visitors. Receives incoming mail and distributes documents appropriately. Coordinates outbound mail and packages while ensuring efficient and timely delivery. Provides clerical support such as word processing, faxing, copying, data entry and mailings, to organizational staff. Orders office supplies and arranges business equipment services with other facility-related vendors as needed. Use of clinical data is limited to: Performance of review of service request for completeness of information; Collection and transfer of non-clinical data; and Acquisition of structured clinical data; and Activities that do not require evaluation or interpretation of clinical information.Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. In addition, all other duties assigned by the manager and/or supervisor.Education:
· Associate degree in Secretarial Science or equivalent experience preferred
· High School degree
Experience:
· Minimum 2 years of experience in administrative assistant position or similar; call center customer service experience.
Knowledge:
· Knowledge in medical billing, preferably in healthcare setting.
· Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
Read LessPosition Summary:
The Health Professional 1-Pharmacy Call Center Representative manages telephone calls from pharmacies and providers related to pharmacy benefits, authorization requests, drug use review, among others, to ensure that claims are correctly and timely adjudicated.
Essential Functions:
1. Answers and manages telephone calls from pharmacies and providers in a timely, confidential and courteous manner.
2. Documents calls and/or drug requests with complete follow-up history of the patient through electronic records.
3. Provides orientation to pharmacies regarding pharmacy benefits.
4. Performs system overrides (e.g., prior authorization) on the PBM claims processing system to ensure that claims are
correctly adjudicated.
5. Assists pharmacies claim processing.
6. Assist in the training of pharmacy representatives.
7. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
8. In addition, all other duties assigned by the manager and/or supervisor.
Education:
Pharmacy Technician Course of accredited school.Possess an active professional unrestricted Pharmacy Technician License in good standing to practice in Puerto RicoExperience:
· Minimum 2 years’ experience in retail pharmacy preferred.
Knowledge:
· Basic knowledge of physical and mental pharmacotherapies, in order to make accurate assessments of clinical cases.
· Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
Read LessResumen del puesto:
El Asistente Administrativo recibe y enruta las llamadas entrantes, saluda a los visitantes, mantiene el registro de visitantes y tarjetas de identificación y proporciona información general y asistencia al público. Esta persona clave recibe el correo entrante y ayuda en la preparación y distribución de materiales de la empresa. El Asistente Administrativo realiza funciones rutinarias de apoyo de oficina, incluyendo procesamiento de textos y archivo. Este empleado no es responsable de realizar ninguna actividad de revisión de UM que requiera la interpretación de información clínica.
Funciones Esenciales:
Realiza actividades de apoyo administrativo y de oficina para múltiples supervisores, tales como entrada de datos, procesamiento de textos, creación de hojas de cálculo, informes y presentaciones, y/o archivo. Recibe y filtra todas las llamadas entrantes y canaliza las llamadas al personal adecuado. Saluda con prontitud a los clientes internos y externos, manteniendo el registro de visitantes y la preparación de tarjetas de identificación. Proporciona información general y orientación a las personas que llaman y a los visitantes. Recibe el correo entrante y distribuye los documentos adecuadamente. Coordina el correo y los paquetes salientes, garantizando una entrega eficaz y puntual. Proporciona apoyo administrativo al personal de la organización, como procesamiento de textos, fax, fotocopias, introducción de datos y envío de correspondencia. Realiza pedidos de material de oficina y gestiona servicios de equipamiento empresarial con otros proveedores relacionados con las instalaciones, según sea necesario. El uso de datos clínicos se limita a: Realización de la revisión de la solicitud de servicio para comprobar que la información es completa; Recopilación y transferencia de datos no clínicos; y Adquisición de datos clínicos estructurados; y Actividades que no requieren la evaluación o interpretación de información clínica.Cumple todas las directrices establecidas por los Centros de Medicare y Medicaid (CMS) y las directrices establecidas por otros organismos reguladores, cuando proceda. Además, todas las demás tareas asignadas por el gerente y/o el supervisor.
Formación:
Asociado en Secretarial o experiencia equivalente preferiblemente. High SchoolExperiencia:
Mínimo 2 años de experiencia en puesto de asistente administrativo o similar; experiencia en atención al cliente en centro de llamadas.
Conocimientos:
Conocimientos en facturación médica, preferiblemente en el ámbito sanitario.La experiencia con ordenadores personales debe incluir el trabajo con Microsoft Word, Excel, Power Point y Outlook a nivel intermedio como mínimo. Read LessPosition Summary:
The Administrative Assistant receives and routes incoming calls, greets visitors, maintains visitor log & badges and provides general information and assistance to the public. This key individual receives incoming mail and assists in preparation and distribution of company materials. The Administrative Assistant performs routine office support functions, including word processing and filing. This employee is not responsible for conducting any UM review activities that require interpretation of clinical information.
Essential Functions:
Performs administrative and office support activities for multiple supervisors, such data entry, word processing, creating spreadsheets, reports and presentations, and/or filing. Receives and screens all incoming calls and channels calls to the appropriate personnel. Greets internal and external clients promptly, while maintaining visitor log and badge preparation. Provides general information and guidance to callers and visitors. Receives incoming mail and distributes documents appropriately. Coordinates outbound mail and packages while ensuring efficient and timely delivery. Provides clerical support such as word processing, faxing, copying, data entry and mailings, to organizational staff. Orders office supplies and arranges business equipment services with other facility-related vendors as needed. Use of clinical data is limited to: Performance of review of service request for completeness of information; Collection and transfer of non-clinical data; and Acquisition of structured clinical data; and Activities that do not require evaluation or interpretation of clinical information.Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. In addition, all other duties assigned by the manager and/or supervisor.Education:
· Associate degree in Secretarial Science or equivalent experience preferred
· High School degree
Experience:
· Minimum 2 years of experience in administrative assistant position or similar; call center customer service experience.
Knowledge:
· Knowledge in medical billing, preferably in healthcare setting.
· Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
Read LessResumen del puesto:
El Asistente Administrativo recibe y enruta las llamadas entrantes, saluda a los visitantes, mantiene el registro de visitantes y tarjetas de identificación y proporciona información general y asistencia al público. Esta persona clave recibe el correo entrante y ayuda en la preparación y distribución de materiales de la empresa. El Asistente Administrativo realiza funciones rutinarias de apoyo de oficina, incluyendo procesamiento de textos y archivo. Este empleado no es responsable de realizar ninguna actividad de revisión de UM que requiera la interpretación de información clínica.
Funciones Esenciales:
Realiza actividades de apoyo administrativo y de oficina para múltiples supervisores, tales como entrada de datos, procesamiento de textos, creación de hojas de cálculo, informes y presentaciones, y/o archivo. Recibe y filtra todas las llamadas entrantes y canaliza las llamadas al personal adecuado. Saluda con prontitud a los clientes internos y externos, manteniendo el registro de visitantes y la preparación de tarjetas de identificación. Proporciona información general y orientación a las personas que llaman y a los visitantes. Recibe el correo entrante y distribuye los documentos adecuadamente. Coordina el correo y los paquetes salientes, garantizando una entrega eficaz y puntual. Proporciona apoyo administrativo al personal de la organización, como procesamiento de textos, fax, fotocopias, introducción de datos y envío de correspondencia. Realiza pedidos de material de oficina y gestiona servicios de equipamiento empresarial con otros proveedores relacionados con las instalaciones, según sea necesario. El uso de datos clínicos se limita a: Realización de la revisión de la solicitud de servicio para comprobar que la información es completa; Recopilación y transferencia de datos no clínicos; y Adquisición de datos clínicos estructurados; y Actividades que no requieren la evaluación o interpretación de información clínica.Cumple todas las directrices establecidas por los Centros de Medicare y Medicaid (CMS) y las directrices establecidas por otros organismos reguladores, cuando proceda. Además, todas las demás tareas asignadas por el gerente y/o el supervisor.
Formación:
Asociado en Secretarial o experiencia equivalente preferiblemente. High SchoolExperiencia:
Mínimo 2 años de experiencia en puesto de asistente administrativo o similar; experiencia en atención al cliente en centro de llamadas.
Conocimientos:
Conocimientos en facturación médica, preferiblemente en el ámbito sanitario.La experiencia con ordenadores personales debe incluir el trabajo con Microsoft Word, Excel, Power Point y Outlook a nivel intermedio como mínimo. Read LessResumen del puesto:
El Coordinador de Calidad 2 asiste al Supervisor de Calidad y en el desarrollo, coordinación e implementación del programa local de mejora de la calidad, garantizando que los objetivos y estándares de rendimiento cumplan y superen las expectativas de calidad. Esta persona clave colabora en los procesos de quejas, apelaciones, incidentes adversos, programación de la formación y elaboración de informes. El Coordinador de Calidad se dedica plenamente a las tareas del Departamento de Calidad.
Funciones esenciales:
Coordina, organiza, analiza y realiza el seguimiento de los TRR, así como la preparación de planes de acciones correctivas. Asistir al Supervisor de QI en el desarrollo, coordinación e implementación de herramientas de indicadores de calidad, tales como monitoreo silencioso, auditorías internas y reuniones del comité de calidad, entre otras. Recopila información de casos para la investigación y resolución de Eventos Adversos y Calidad Asistencial.Recopila datos, mantiene bases de datos y colabora en la identificación de oportunidades de mejora. Elaboración de informes mensuales, trimestrales y anuales. Cumple con todas las directrices establecidas por los Centros de Medicare y Medicaid (CMS) y las directrices establecidas por otras agencias reguladoras, en su caso. Además, todas las demás tareas asignadas por el gerente y/o el supervisor.Formación:
Maestría en un campo de salud conductual. Licencia(s) clínica(s) vigente(s) y sin restricciones para ejercer en el territorio de Puerto Rico.Experiencia:
Mínimo 2 años de experiencia en Atención Gestionada, Gestión de Salud Mental y/o Mejora de la Calidad Sanitaria preferiblemente.Conocimientos:
La experiencia informática personal debe incluir el trabajo con Microsoft Word, Excel, Power Point y Outlook a nivel intermedio como mínimo. Read LessPosition Summary:
The Quality Coordinator 2 assist the QI Supervisor and in the development, coordination, and implementation of the local quality improvement program, ensuring that performance objectives and standards meet and exceed quality expectations. This key individual assist with complaints, appeals, adverse incidents, training scheduling and reporting processes. The Quality Coordinator is fully dedicated to duties of the Quality Department.
Essential Functions:
Coordinates, organizes, analyses, and provides follow up for the TRR, as well as prepare corrective action plans. Assist QI Supervisor in the development, coordination and implementation of quality indicators tools, such as silent monitoring, internal audits, and quality committee meetings, among others. Compiles case information for the investigation and resolution of Adverse Events and Quality of Care.Collect data, maintain databases, and assist in identifying opportunities for improvement. Development of monthly, quarterly and annual reports. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. In addition, all other duties assigned by the manager and/or supervisor.
Education:
Master’s Degree in a Behavioral Health field. Current, unrestricted clinical license(s) to practice in Puerto Rico territory.Experience:
Minimum 2 years of experience in Managed Care, Behavioral Health Management and or Healthcare Quality Improvement preferred.Knowledge:
Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum. Read LessPosition Summary:
The Health Professional 3/MCI its responsible for providing intensive follow-up to members exhibiting behavior or an environment that may predispose them to incompliance with medical treatment thus resulting in increased hospitalizations, costly treatments and/or worsening of their mental health status. Intensive follow-up may consist of telephonic follow-ups, home visits, integration and coordination care with community agencies and coordination depending on the necessity.
Essential Functions:
1. Conducts health risk assessment and identifies barriers that could affect or interfere with treatment effectiveness or adherence
2. Communicates with providers in the community regarding the consumer’s treatment needs and develops appropriate care plans for specialized needs of members
3. Follow-up by telephonic or/and community outreach and crisis intervention if necessary.
4. Provides chronic care management, empowerment, motivational interviewing, services coordination and other clinically based activities as assigned, based upon member’s severity of condition.
5. Educates the patient about their disease state as well as other health issues relating to their plan care.
6. Collaborates with other professionals to obtain better treatment results and overall care
7. Investigates, reviews and maintains data related to treatment, care and/or related services
8. Establish case discussions with Medical Consultant and/or Medical Director
9. Will represent the company in Court for cases under follow-up and prepare reports if necessary.
10. Documents all activities per APS policies and procedures.
11. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
12. And all other duties assigned by the manager and/or supervisor.
Education:
· Bachelor’s Degree in a Behavioral Health field; Master’s Degree preferred.
· Current, unrestricted license to practice preferred.
Experience:
· Minimum 2 years of experience in a Clinical, Behavioral or Managed Care field preferred.
Knowledge:
· Strong knowledge in behavior principles, chronic illnesses and disease management.
· Strong telephonic assessment and customer service skills.
· Knowledge in community based resources.
· Knowledge in clinical assessment and crisis intervention.
· Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
Read LessPosition Summary:
The Health Professional 3/RN provides health and wellbeing services as part of the clinic’s multidisciplinary team. This key individual promotes and restores patients' health in collaboration with physicians and multidisciplinary team members. The main responsibility will be integrate de psychological and physical areas of our patient.
Essential Functions:
Completes initial interview with the patient; reviews and analyzes data collected in order to identify specific needs, strengths and limitations. Recognizes and carefully manages urgent patients, as well as implements the necessary actions in case of emergency or hospitalization, based on Law 408 and the company’s procedures. Coordinates patient transfers to the appropriate health care setting. Develops a patient treatment plan with a multidisciplinary focus, while promoting patient participation in treatment strategies. Discusses clinical cases and procedures with other team members in order to collect important information for treatment strategy elaboration. Assures that all patients at the clinic triage have completed an arterial pressure, pulse, and vital signs check. Collaborates in urine test collection in order to determine drug abuse/use as needed. Controls and administers the Drug Deposit and evaluates patients for the clinics depot. Contacts and monitors the attendance of depot patients. Keeps drug inventory and temperature monitoring in accordance with Pharmacy regulations. Maintains communication with patient’s family members and provides supplementary treatment as needed. Provides individual or group advice to patients and family members about use and abuse of medication, or in any topic needed for treatment. Documents patient intervention and properly stores all suitable forms in the patient’s file. Maintains registry of all patient care medication. Identifies potential treatment side effects and reports findings do Clinic Administrator, Physician and or Pharmacy Department. Coordinates and performs medical communication with patient Physical PCP ad necessary. Transfers patients to other facilities when needed. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. In addition, all other duties assigned by the manager and/or supervisor.Education:
Bachelor’s degree in Nursing required Must have current, unrestricted PR License to practice in Puerto Rico territory, with current Professional Nursing College Membership.Experience:
Minimum 2+ years of experience in the mental health and or/nursing field.Knowledge:
Knowledge of medication, drug interactions, side effects, incompatibilities and all issued related to proper treatment. Knowledge of diagnosis and pharmacology.Knowledge of mental health regulations and related laws.Must be able to prioritize and target interventions, consistent with state licensure scope of practice requirements designed to support long-term behavioral change. Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum. Knowledge regarding nursing process and correct administration guidelines.