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EmblemHealth
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  • AdvantageCare Physicians (ACPNY) is a primary and specialty care pract... Read More
    AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area. With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our services for communities throughout New York. As we grow, our employees grow with us. Summary of Position Provide professional nursing care to patients and proactively support efforts to ensure that standards for patient satisfaction, patient safety, and quality of care are maintained, as established by AdvantageCare Physicians. Primary liaison between patients, staff and physicians and support the Advanced Care Model. Organize and provide clinical supervision to the specialty patient care team including, but not limited to, delegation of responsibilities, mentoring, evaluating, educating, scheduling and counseling the care team staff. Principal Accountabilities Provide general nursing care to patients including administering prescribed medications and treatments in accordance with nursing standards and per orders; planning, articulating, and coordinating care and interventions; maintaining consideration for specific age-related characteristics, needs related physical development, communication, socialization and safety, in collaboration with other members of the care team. Ensure nursing practices of the specialty care team as well as own practices are in accordance with nursing standards, local, state and federal guidelines and organizational policy. Provide clinical supervision to the Licensed Practical Nurses (LPNs) and Care Team Associate IIs (CTA II) on the specialty care team. Assist with daily/weekly Care Team scheduling. Delegate tasks appropriately according to the scope of licensure and follow up on delegated tasks to ensure completion. May function as the Lead Nurse in the medical office when the Manager, Nursing (and/or Assistant Manager, Nursing) is unavailable or has not been designated. Assist with new hire orientation, staff training, providing feedback for performance evaluations, and providing information related to employee discipline and termination of staff. Coordinate and manage daily huddles. Prepare and manage materials and deliverables. Review patient charts for missing labs, reports, and/or open orders and review as part of care team huddles. In coordination with the Manager, Nursing and Practice Administrator, manage and inventory clinical supplies. Prepare equipment and aid physician during treatment, examination, testing of patients and patient procedures. Verify chief complaint and take vital signs as requested. Review the EHR (electronic health record) active medication list with patients. Conduct and document point-of-care tests based on protocol. Administer medications as directed by provider. Contact patients with test results and provide recommendations on cases per physician determination and/or standards of care. Add recommendations to individualized care plan(s) and review After Visit Summary (AVS) with patient. Facilitate clinical messages and chronic condition management education to patients. Document progress notes in electronic health record within 24 hours. Manage in-basket requests and responds to all requests in a timely manner. Serve as a clinical liaison between the call center and medical office. Triage urgent same day or double-booked appointment requests. Identify patients who may need point-of-care testing as well as patients with special needs (i.e., transportation). Coordinate outpatient work-up and or treatment plans when required (i.e. further clinical testing, x-rays, and facilitate communication between physicians and health care providers). Pend tests and procedure orders for physician approval and co-signature. Prepare prescriptions or medication refills, for review and signature by provider. Provide patient education on self-management of chronic conditions. Accountable for the administration, treatment and training of patient self-administered drugs. Perform other job-related duties as required including participation in nursing practice work groups and committees. Qualifications Education, Training, Licenses, Certifications Graduate of an accredited school of nursing Bachelor's degree in nursing preferred Current unencumbered New York State Registered Nurse license BLS ACLS required for GI and Cardiology Relevant Work Experience, Knowledge, Skills, and Abilities Work experience as a nurse in a hospital or ambulatory setting preferred Work experience in specific specialty (only for those roles where a specialty area is listed, e.g. Cardiology, Gastroenterology) preferred Experience with American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) Accreditation (GI position only) preferred Strong knowledge of professional nursing theory, regulations and practices to give and evaluate patient care Skill in applying and modifying the principles, methods and techniques of professional nursing to provide ongoing patient care Knowledge of medical chart reporting Ability to maintain quality control standards including knowledge of policies and procedures related to infection control, environmental safety, patient confidentiality and common safety hazards and precautions to establish/maintain a safe work environment Ability to work independently within scope of practice, make appropriate clinical decisions and delegate appropriately Excellent verbal and non-verbal communication skills to provide patient care and interact with colleagues in a team atmosphere Knowledge or electronic medical records (EMR) preferred Additional Information Requisition ID: 1000002986 Hiring Range: $81,000-$96,900 Read Less
  • Summary of Position Responsible for the safe, timely transportation of... Read More
    Summary of Position Responsible for the safe, timely transportation of supplies, marketing equipment, and materials to the appropriate destinations. Responsible for the daily operation, maintenance, and organization of EmblemHealth's Community Outreach Vehicles (COVs), cargo vans, and RVs at assigned marketing locations. Provide technical, administrative, and logistical support in executing community events for Marketplace Sales to facilitate the selling and engagement functions. Assist with the management of company sales events, sponsorships, and community activations. Ensure the sales department staff have a professional and functional environment to engage with community members and support enrollment efforts. Principal Accountabilities Sales Operations Enablement: Scout and secure approved parking/event locations within the assigned catchment area. Identify safe and legal space to set up displays and working area. Perform daily setup, breakdown, and transport of marketing equipment (tents, tables, banners, marketing material, supplies, A-Frames, etc.). Support Sales Reps with administrative tasks (distribute flyers and other materials, assist with lead collection). Engage with members of the public to generate or discern interest in speaking with our reps about health insurance. Maintain communication with Fleet and Sales Management, report competitor activity or marketing obstacles. Company Vehicle: Maintain an efficient, organized, and clean vehicle (interior a valid driver's license with less than 3 moving violations within the past three years. Relevant Work Experience, Knowledge, Skills, and Abilities 2 - 3+ years of relevant, professional work experience required Extensive experience driving in various NY neighborhoods required Additional experience/specialized training may be considered in lieu of degree requirement. Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required Ability to perform minor vehicular maintenance tasks (e.g., checking and replacing wiper fluid, checking oil/fuel levels, checking tires, etc.) required. Ability to lift and transport materials and equipment weighing up to 100 lbs required. Strong communication skills (verbal, written, interpersonal) with all types/levels of audiences required. Strong organizational skills; ability to manage and maintain inventories required. Prioritizing and problem-solving skills; ability to effectively manage logistical tasks required. Must be willing and able to work "off hours" such as evenings, weekends, holidays, etc. as needed required. Additional Information Requisition ID: 1000002760_05 Hiring Range: $48,600-$60,000 Read Less
  • Summary of Position Work closely with onsite sales colleagues to ident... Read More
    Summary of Position Work closely with onsite sales colleagues to identify customers in need of enrollment services and provide post salescustomer service follow-up. Interact face-to-face with customers, assisting in providing complete resolution of customer concerns including claims, benefit and enrollment inquiries through health plan navigation, health and wellness coaching and community referrals. Proactively research Emblem Health member issues utilizing multiple enterprise systems and data to explain and resolvecomplicated customer service issues, close care gaps, helping complete HRAs, enabling higher retention of members within the neighboring community. Help conduct seminars and workshops on premises and will play an important role in class offerings for the department. Collaborate with enterprise team members on member retention efforts and special projects within the location including:Care Management and Quality to understand member needs in the community as they relate to gaps in care; and quality efforts to provide effective in person and outreach services within the community. Provide post sales customer service follow-up with Sales colleagues, both onsite and in the field within the region, to follow up on member customer service and care needs. Work with ACPNY teams, both co-located and within the region, to aid in care gap issues, especially as they relate to social needs and customer service follow up. Represent EmblemHealth to all visitors to the sites, including internal and external partners, groups and leaders. Maintain a primary Neighborhood Care location but also support multiple Neighborhood Care sites within a region. Principal Accountabilities Identify customer needs and help solve customer issues related to health plans, health and wellness and enrollment within regulatory guidelines; providing direct guidance or identifying other EmblemHealth (EH) and community resources to find customer solutions, conduct customer needs assessment, education on condition management. Understand and maintain excellent working knowledge of EmblemHealth products, services and technology platforms. Document interactions in support of quantitative metrics for the site and department. Work with the manager to deliver and organize onsite health seminars and classes, including EH vendor-led classes. Proactively communicate with customers, EmblemHealth departments and community partners the status of any outstanding issues until solved. Effectively describe final resolution to customer. Work together with sales team to identify customers in need of enrollment services and post sales customer service follow-up. Proactively support operational aspects of other internal partners such as AdvantageCare Physicians, product, customer service and quality to help improve customer experience and operations. Participate in weekly meetings with manager and team members across sites to discuss customer care issues, improvement opportunities, community offerings, and other site and company priorities Represent EmblemHealth at onsite interactions with community partners and leaders. Qualifications Education, Training, Licenses, Certifications Bachelor's Degree Relevant Work Experience, Knowledge, Skills, and Abilities 3 - 5+ years of experience working with customers in customer service, medical or managed care environment. Experience in evidence-based health and lifestyle coaching techniques. Ability and willingness to attend appropriate training and certification classes. Additional experience/specialized training may be considered in lieu of educational requirements. Experience communicating directly with customers, assessing needs, and connecting customers with resources. Knowledgeable on how to navigate all aspects of medical care and managed care system, and health and wellness. Ability to demonstrate excellent service knowledge and hospitality, and optimistic warmth and empathy for the customers' experience. Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences. Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.). Technologically savvy, with the ability to quickly learn and navigate different information technology systems. Flexibility to work in different Neighborhood Care sites when needed. Bilingual Creole preferred. Additional Information Requisition ID: 1000002889 Hiring Range: $56,160-$99,360 Read Less
  • Summary: Collaborate with AVP to maximize organizational efficiency an... Read More
    Summary: Collaborate with AVP to maximize organizational efficiency and effectiveness through the optimization of business processes. Identify inefficiencies and performance gaps; gather and interpret data and information to identify root causes; develop strategies; implement changes to improve workflows, reduce costs, and enhance overall performance. Analyze business processes to determine levels of interconnectedness may impact other parts of the business; collect information about current procedures, outputs and metrics to develop a baseline of how the company works. Compare internal processes to industry standards or competitor performance to identify gaps and set goals. Use historical business data to assess the cost and benefit of each business system and process. Assess internal organizational structures; rearrange hierarchies and workflows to improve efficiency. Work alongside department heads and team members to communicate the importance of efficient processes and lead change initiatives effectively. Research new equipment, techniques, and technologies to incorporate into the business. Collaborate with departments to design improvement strategies that align with the organization's goals. Work with cross-functional teams to gather input, implement changes, and ensure buy-in. Develop implementation plans and develop step-by-step procedures and timelines for each modification. Lead projects to implement solutions, which may involve adopting new technologies, revising workflows, or improving employee training. Provide training and support to employees on new processes and procedures. Monitor the performance of implemented changes; make adjustments as needed to ensure sustainable results. Establish metrics to monitor the success of process improvements; track key performance indicators (KPIs) and make adjustments as needed to maintain optimal performance. Communicate process improvement initiatives, recommendations, and findings/results to all stakeholders. Prepare reports for management that detail improvements, outcomes, and recommendations for further process enhancements. Responsibilities: Work with the AVP to build and leverage relationships to provide innovative solutions to complex business problems. Serve as the subject matter expert in Project and Portfolio Management methodology and best practices. Manage a variety of viewpoints to build consensus and create positive outcomes for all parties involved. Utilize financial modeling and forecasting to support project prioritization and resource allocation. Partner with Finance to validate business cases, monitor budget adherence, and assess financial impact of strategic initiatives. Serve as main point of contact for centralized services such as project definition, planning, scheduling, pricing, risk assessment and tracking to effectively monitor the committed time, scope and budget of the projects. Actively lead in project status meetings; may lead on project Steering Committees of mission critical projects. Track and report on risks and opportunities and how they may impact the financial results and projections by developing close ties to key financial and operational leadership. Uphold the enterprise's code of ethics and business conduct. Responsible for coordinating multiple, complex projects based on the overall enterprise strategy and resource capabilities. Partner with the stakeholders, business owners, and when necessary, the IT organization. Provide guidance and oversight on mission-critical projects to meet business deadlines; develop mitigation strategies as warranted; and work with business on monitoring financial performance of funded projects. Collaborate with AVP and departmental senior management to oversee strategic project management documentation and methodologies including policies, standards, procedures, and necessary technologies. Consult and mentor the project management community throughout the project lifecycle; monitor adherence to PM standards and methodology. Provide direction to identify/remediate/mitigate, when possible, any major project management risks. Collaborate with AVP/department on decisions regarding utilization of project resources. Develop and maintain financial dashboards and KPIs to track project performance and value realization. Identify critical resource needs and negotiate with functional resource managers to secure allocation to the project and to ensure projects progress in accordance with agreed upon deliverables. Reprioritize work as business and strategy needs dictate and facilitate discussions at all levels of the organization. Partner with IT as needed for technical workstream as part of overall project. Provide oversight of the relationships between the entire project team including external vendors and suppliers that are engaged with the project. Conduct Financial impact assessments and scenario planning to support strategic decision-making. Track and manage all project action items to timely resolution. Utilize finance metrics to determine degree of success for projects; report on results to senior management. Manage project completion postmortem to ensure gathering of Lessons Learned and call outs for future projects Qualifications: Education, Training, Licenses, Certifications Bachelor's degree required; master's preferred Lean Six Sigma certifications (e.g., Black Belt, Master Black Belt) or equivalent/related preferred Coursework or certification in corporate finance, financial planning, actuarial science, or data analytics is preferred Relevant Work Experience, Knowledge, Skills, and Abilities 10 - 12+ years' professional business experience, preferably in the Healthcare Payer business required 5+ years of experience managing large and highly complex Healthcare Payer projects required 5+ years of progressively responsible experience in a leadership role, with a focus on process improvement or quality management required 3+ years' experience in Management Consulting or Investment Banking required Proven ability to oversee multiple improvement projects; strong organizational, prioritizing and time management skills required Strong understanding of project related business case development and cost benefit analysis required Demonstrated ability to translate strategic plans into financial outcomes and performance metrics required Strong knowledge of process improvement methodologies, data analysis, and performance measurement tools required Strong problem-solving and analytical skills; ability to dissect complex processes, identify inefficiencies, and design effective solutions. Ability to adapt strategies to fit different contexts required Ability to form, lead and motivate teams, influence stakeholders, drive change, and to work effectively with cross-functional teams across the entire organization required Strong financial acumen with experience in budgeting, forecasting, and financial analysis preferred Experience working with finance teams to develop and monitor project budgets and ROI required Ability to quickly identify and address operational blocks and impediments to efficiency and effectiveness required Strong attention to detail and ability to see how small inefficiencies can have a significant impact on overall performance required Ability to assess and develop risk mitigation strategy recommendations and to capitalize on opportunities required Ability to build and maintain relationships with staff up to and including leadership required Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences, including stakeholders; ability to explain technical concepts clearly and build support for change required Expert knowledge of Microsoft Office tools, (Excel, Word, PowerPoint, Teams, Outlook) required Additional Information Requisition ID: 1000003054 Hiring Range: $113,400-$210,600 Read Less
  • AdvantageCare Physicians (ACPNY) is a primary and specialty care pract... Read More
    AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area. With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our services for communities throughout New York. As we grow, our employees grow with us. Summary of Position The Care Team Associate II serves as a member of the Care Team in the treatment and care of patients who assists providers with clinical services and administrative tasks to support population health guided best in class care. The position works under the supervision of the Practice Administrator and in collaboration with the Nurse Manager. The Care Team Associate II must understand basic medical terminology, demonstrate customer service excellence, have the ability to recognize data reflective of the patient's status and inform the RN/LPN of his/her observations. Principal Accountabilities Warmly greets and engages in friendly conversation with Advantage Care Physicians (ACP) patients and guests. Works with office staff to effectively communicate approximate wait times and maintains timely communication to patient and guests. Monitors patient flow in waiting room and assesses patients' and guests' needs as they wait. Proactively resolves patient flow issues related to registration, check-in, and check-out processes. Assists patients in resolving patient service or clinical issues as needed. Answers telephones in a professional manner utilizing excellent customer service skills exhibited by courtesy, cooperative spirit, and tact when interacting with employees, patients and visitors. Utilizes standard ACP greeting at all times when answering the telephone. Schedules patient appointments accurately in computer system. Verifies insurance coverage, as required. Takes the initiative to resolve all patient concerns and issues. Checks-in patients and prepares and processes appropriate forms. Serves as a reference source regarding hours of operation, directions, transportation and general ACP policies. Performs a complete registration of patient's demographic and financial information using electronic systems as needed. Responsible for the integrity of the data. Scans documents into the electronic systems, as assigned. Checks-out patients at the end of the visit, verifying that patients have all required documentation prior to leaving the medical facility. Thanks patients as they leave and solicits feedback about the quality of service and experience. Takes complete and accurate IB messages from all individuals contacting the medical facility by telephone, including messages related to patient needs intended for providers and clinical staff. Delivers messages to the intended recipient in a timely manner. Escalates calls pursuant to the ACPNY call escalation policy. Checks email correspondence, electronic task lists, and other written communication regularly throughout the business day to enable timely knowledge of and response to written correspondence. Collects cash from patients for charges and co-payments and provides patient receipts. Completes all necessary documents for all payments accrued. Matches cash collected to receipts at end of session. Performs accurate end of day reconciliations. Makes reminder and "no show" calls. Prints schedules and confirms appointments. Sends correspondence to patients' residences in order to remind, recall or reschedule appointments. Coordinates internal and external referrals to specialists by coordinating and scheduling all appointments, providing appointment date and time reminders, providing directions to the specialist's office and copies of any pertinent medical records or tests needed for the specialty appointment. Coordinates additional tests as needed. Utilizes the EPIC preferred provider list and/or external provider list for the coordination of referrals. When requested, provide patients with a list of three external specialists to satisfy their request to research and select their own specialty provider. Reviews the referral WQ daily to address any referrals which may have been ordered in a non-face to face encounter, such as an in-basket message and proceeds to arrange these referrals. Acts as a liaison between ACPNY and external specialists for outpatient procedures performed at other facilities, i.e. interventional, surgical or other. Provides data as necessary and conducts all necessary follow up. Acts as the key point of reference to communicate with patients on pre-and post-referral appointment matters. Assists care teams with campaigns/initiatives such as the Influenza program and the Health outcome survey and closing gaps in care. Provides information to patients and assists them in getting the care they need. Under the direction of the Practice Administrator, conducts regular outreach to identified "at- risk patients" to reduce unnecessary ED visits and admissions. Maintains effective communication with patients, families, peers and other members of the health care team. Attends all meetings as directed by practice administrator/designee. Demonstrates flexibility in the acceptance and completion of work assignments. Effectively takes action without being told (e.g., takes initiative) within the scope of his/her responsibilities. Recognizes and performs duties which need to be performed although not directly assigned. May be assigned, on a temporary and short-term basis, to other medical offices based on ACP's staffing need. Demonstrates proficiency with computer systems (e.g., electronic practice management/electronic health record) within 3 months of training as evidenced by the following metrics: patient registration quality, time to check in, cash draw closing, referral WQ management Completes all tasks on the electronic system required for the job function consistently, accurately, and in a timely manner. Demonstrates professionalism in attitude, dress, decorum, and interaction with patients, clients and co-workers. Adheres to the ACP's dress code. Arrives on time for assigned shift and maintains a punctuality and attendance record consistent with ACPNY Time and Attendance policies. Respects patient confidentiality and withholding restrictive information. Demonstrates good judgment, discretion and ability to problem solve. Contributes to a cooperative, friendly and mutually supportive work environment: a "team" player. Participates and supports the care team in direct patient care under the supervision of an RN/LPN Supervisor. Performs duties involving direct patient care as assigned by the RN/LPN Supervisor/MD within the framework of ACP policies and procedures. Identifies physical, behavioral, and emotional characteristics typical for the age group of the patient receiving care. Modifies approaches based on patient age-specific needs and responses to treatment. Performs a variety of patient care functions based on age-specific needs using age-appropriate communication techniques. Patient care functions include but is not limited, to the following: physical examination preparation, personal history/medications/allergies recording in the EMR, vital signs, phlebotomy, heights, weights, finger sticks, electrocardiograms, head circumference measurements, vision and hearing screening, set up oxygen and suction, pulse oximetry, peak flow testing, Provide PHQ-9 (mental state questionnaire), urine dipstick (exclude interpretation), and urine pregnancy (exclude interpretation). Chaperones during patient examinations, as needed. Provides medication verification on recently hospitalized patients and ensures recent labs have been scanned. Notifies appropriate staff of patient's status. Documents pertinent patient care information in the electronic medical record. Collects and accurately labels specimens. Prepares specimens and required paperwork for collection by affiliated laboratories. Retrieves lab, pathology and diagnostic data from the outside laboratories, collates for upcoming visits. Ensures that all pertinent equipment is sterilized according to schedule based on the purpose for and use of the equipment. Notifies appropriate personnel regarding any malfunction in equipment. Keep examination rooms neat and clean. Restocks exam/treatment rooms and medical supply inventory on a daily basis. Completes all necessary forms in an accurate and timely manner. Assists with various medical procedures, as required, e.g., sigmoidoscopies, colposcopies, and biopsies consistent with the NY State Nursing Guide to Practice (NYSEDOP). Performs other job-related duties as required. Qualifications Education, Training, Licenses, Certifications High School diploma or GED Associate degree preferred Certificate of completion from an accredited Medical Assistant Program required or eligibility to sit for the national certification exam and pass the exam within 18 months of hire Relevant Work Experience, Knowledge, Skills, and Abilities Minimum 1 year experience as medical assistant in an ambulatory care setting Three years' experience as medical assistant in an ambulatory care setting preferred Experience and ability to navigate an EMR (Electronic Medical Record) Additional Information Requisition ID: 1000003005 Hiring Range: $24.20 per hour Read Less
  • Summary of Job Provide advanced oversight of vendor performance and pr... Read More
    Summary of Job Provide advanced oversight of vendor performance and provider data integrity across core operational processes. Ensure adherence to contractual requirements, regulatory expectations and customer experience standards. Lead analytics, drive continuous improvement initiatives and contribute subject matter expertise to cross-functional projects. Partner with key business areas to identify risks, enhance workflow efficiency, and strengthen data quality. Responsibilities Assess and monitor performance of vendors for each core process to ensure contractual requirements are met and that results align with EmblemHealth customer experience objectives. Conduct reviews, transactional audits, compliance checks and operational procedure assessments for all vendor-supported processes. Analyze performance data to compare intended versus actual outcomes, evaluate quality controls, and identify system or process gaps. Monitor and drive policy, procedure and reference tool creation and maintenance. Communicate findings through SAS-based reports, executive presentations, and detailed performance summaries. Drive key project activities and contribute subject-matter expertise within project teams and strategic workgroups aligned with enterprise initiatives. Provide guidance and mentorship to Provider File Specialists, supporting skill development, knowledge growth, and process proficiency. Work collaboratively with business partners to identify operational risks, communicate opportunities for improvement and drive process enhancements. Maintain meticulous audit and assessment records, perform trend analyses against historical baselines, and document variation events and corrective actions. Participate in cross-functional and vendor related projects as assigned. Perform other duties as directed, assigned, or required. Qualifications Bachelor's degree from an accredited four-year college. 4 - 6+ years of relevant, professional work experience including auditing and assessment activities (Required) Additional years of related experience/specialized training may be considered in lieu of degree requirements (Required) Excellent collaboration skills and the ability to influence management decisions (Required) Strong auditing skills that can be applied across all types of business problems (Required) Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required) Ability to organize, prioritize, and successfully manage multiple competing tasks/projects simultaneously (Required) Previous Provider File or equivalent experience (Required) Proficient in MS Office - Word, Excel, Access, PowerPoint, Outlook, Teams, SharePoint, etc. (Required) Additional Information Requisition ID: 1000003007 Hiring Range: $56,160 - $99,360 Read Less
  • Summary of Position Manage the day-to-day responsibilities of telephon... Read More
    Summary of Position Manage the day-to-day responsibilities of telephone performance, coaching/counseling the customer service team, and inventories of offline work including eCorrespondence, social media, and HIPAA/Privacy form updates. Responsible for systemic testing related to updates to the CRM and the website portal; assist in training initiatives. Drive weekly meetings with call center management of other call centers and regularly attends configuration/grooming sessions for new systems and software. Provide recommendations for process improvements. Able to work all operating hours between 8:00a.m.-8:00p.m. This role is the 11:00a.m.-8:00p.m. shift. Principal Accountabilities Manage staff production and performance in order to meet corporate performance goals. Provide ongoing coaching and feedback to staff. Provide staff with appropriate resolution technique for sensitive calls, especially of a high priority nature. Serve as point/escalation person to answer the most complex telephone inquiries. Identify and coordinate staff training needs to ensure uniform, professional responses. Plan and organize the daily operation of the Service Department, including the processing of payroll for staff. Monitor and review attendance of staff to ensure proper levels of coverage. Analyze and trend inquiry types to identify process improvement opportunities, including development of educational material for staff. Monitor and optimize inventory levels of eCorrespondence, social media and HIPAA form updates to ensure timely resolution. Regular attendance is an essential function of the job. Perform other duties as assigned or required. Qualifications Bachelor's degree; additional years of related experience/specialized training may be considered in lieu of educational requirements required 3 - 5 years of relevant, professional work experience required 3+ years of customer service experience, preferably in operations or in a call center environment required 3+ years of claims related experience required Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience required 2+ years of supervisory experience in a customer service or health care environment preferred Extensive knowledge of insurance contracts, medical, hospital and dental procedures preferred Additional Information Requisition ID: 1000002982 Hiring Range: $56,160-$99,360 Read Less
  • AdvantageCare Physicians (ACPNY) is a primary and specialty care pract... Read More
    AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area. With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our services for communities throughout New York. As we grow, our employees grow with us. Summary of Position We are seeking an experienced Internal or Family Medicine trained physician to join us in pursuit of high-quality patient care to provide a full scope of primary care services including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance. The Ideal Candidate: Must have a minimum of two to three years of primary care clinical experience in an outpatient setting. Ability to diagnose and treat a wide variety of chronic conditions and improve patient outcomes. Demonstrate competency in diagnosis and treatment to assure high standards of patient care and safety are maintained. Patient-centered approach toward a positive patient experience. Excellent communication skills. Interest in Population Health Management. Principal Accountabilities Review patient's history and perform physical examinations. Evaluate, diagnose and provide appropriate treatment and patient care. Refer patient to specialist as needed. Provide quality clinical diagnostic skills in the delivery of patient care. Review all test results and recommend suitable management for the patient, including but not limited to, preventive health recommendations and habits. Prescribe medications and formulate ongoing treatment and disease management plans. Provide relationship-centered care, considering the patient's psychosocial and physical needs. Collect and record patient information, such as medical histories, reports and examination results. Maintain complete and accurate medical records. Communicate effectively with the clinical team to insure total delivery of quality care. Participate in medical staff educational programs and meetings. Qualifications Education, Training, Licenses, Certifications Doctor of Medicine (MD), Doctor of Osteopathy (DO) or foreign equivalent Completion of three year post graduate medical training from a U.S. accredited residency program in Internal Medicine or Family Medicine Relevant Work Experience, Knowledge, Skills, and Abilities Relevant Work Experience, Knowledge, Skills, and Abilities Seeking experienced providers Board Eligible/Board Certified in Internal Medicine or Family Medicine Must possess current, unrestricted New York State license. Must possess active Drug Enforcement Agency (DEA) registration or be eligible for registration Must possess active Medicare/Medicaid Enrollment or be eligible to enroll BLS or ACLS required. Must possess strong communication skills both oral and written Comfortable with Electronic Medical Record (EMR) system and Microsoft Office Additional Information Requisition ID: 1000003019 Hiring Range: $250,000-$280,000 Read Less
  • Summary of Position Provide Claims project management oversight to ens... Read More
    Summary of Position Provide Claims project management oversight to ensure that outcomes are within defined parameters of cost, efficacy, and timeliness. Collaborate with all levels of functional area management to effect desired outcomes related to Claims projects. Serve as technical and business content expert for claims; and as Claims subject matter expert both within Claims Operations oversight and with external support areas. Support the Claims Department with ongoing efficiency improvements; perform project management, resolve problematic claims processing issues utilizing research and analysis to determine root causes; identify and recommend corrective actions;ensure successful system and procedural modifications. Work directly with support areas (IT, Legal, Compliance, PFO, Customer Service and the Cognizant Claims Tower) as indicated based on outcome of research/analysis. Job Responsibilities Serve as liaison between Claims functional group(s); provide guidance, directions, recommendations for issue resolution; assist with implementation of solutions; provide process improvement recommendations. Collaborate with end users to identify impediments to accuracy/productivity; provide direction on possible solutions. Lead cross-functional teams (Payment Integrity, Provider Claims Resolution, Grievance and Appeals, Provider Network Management, Customer Service) to track/monitor the resolution of Claims Issue (medical, hospital and dental) for HMO/PPO claims (Facets). Monitor/Analyze claims issues to identify trends, inefficiencies, and potential risks. Prepare a mitigation plan to resolve outstanding claims issues. Work with other functional areas to provide expertise and guidance where appropriate. Lead cross-functional teams, collaborating with business stakeholders, IT, and other departments to prioritize projects, ensure effective project execution and claims issue resolutions. Clarify benefits, review procedural documents and system/benefit/contract configurations to determine validity of inquiry; interface with Cognizant Claims review technical requirements document. Participate in QA/UAT Test plan reviews ensuring problematic or specific scenarios are included in the test plan. Participate in implementation walkthroughs and review related procedural documents prior to "go live" date ensuring training needs have been identified and communicated to all affected parties. Manage high priority/high visibility processing project requests to completion as assigned. Participate in corporate projects, interdepartmental projects and meetings as the Claims representative. Manage receipt and assignment of projects from Provider Network Management and Customer Service which require review/reprocessing. Work with Cognizant Claims Tower to manage adjudication of problematic claims until system modifications are completed; vet workarounds and document workarounds to support staff education. Participate in review of current procedure documents (CMORE documents) that are due for annual review; identify needed updates. Contribute to corrective measures associated with Quality findings and remediation opportunities. Recommend and facilitate implementation of changes to procedures and policies that result in improved operational efficiencies. Facilitate implementation of workflow changes within Claims Tower and between support departments to improve operational efficiency. Request ad-hoc reports and oversee completion to ensure appropriate data is presented as per request. Monitor variety of reports to ensure accurate claims payment. Qualifications Bachelor's Degree Project Management (PMI) or Six Sigma/related certification preferred 4 - 6+ years' experience with claims, claims support, vendor oversight, analytics and/or UAT management required Health plan industry experience required Proven track record of successfully managing medium to large (division/department) projects required Experience in staff and process management in positions with a history of increasing responsibility required Additional years of experience and/or training/certifications may be considered in lieu of educational requirements required Experience utilizing metrics and analytics to define and verify outcomes and performance relative to SLAs required Health plan functional, operational, analytic and/or UAT domain expertise required Strong communication skills (verbal, written, presentation, interpersonal) required Proficiency in MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.) required Additional Information Requisition ID: 1000002775 Hiring Range: $68,040-$118,800 Read Less
  • Summary of Position Perform clinical reviews within the Medical Manage... Read More
    Summary of Position Perform clinical reviews within the Medical Management Operations Concurrent Review utilization management department. Ensure accurate administration of benefits, execution of clinical policy and timely access to appropriate levels of care. Principal Accountabilities Under the direction of the leader, is responsible for the execution of efficient departmental processes designed to manage inpatient utilization within the benefit plan. Act as the clinical coordinator collaborating with members and facilities to evaluate member needs within the inpatient setting. Establish and maintain active working relationships with assigned facility care managers/utilization management departments to facilitate appropriate clinical reviews and patient care. Enter and maintain documentation in the TPH platform meeting defined timeframes and performance standards. Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and business standards. Review and investigate member and provider requests to determine appropriate utilization of benefits and/or claim adjudication. Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making coverage determinations and recommendations. Prepare and present clinical case summaries in routine inpatient rounds. Maintain an understanding of utilization management, program objectives and design, implementation, management, monitoring, and reporting. Identify quality, cost and efficiency trends and provide solution recommendations to Supervisor/Manager. Actively participate on assigned committees. Perform other related projects and duties as assigned. Qualifications Associate's degree or bachelor's degree in nursing Valid RN License without restriction May require a CME accreditation in specific specialties Certification in utilization or care management preferred 4 - 6+ years of Nursing experience Case and/or utilization management/care coordination and managed care experience Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience Organizing and prioritizing skills, and strong attention to detail Trained in the use of Motivational Interviewing techniques Experience working in physician practice and/or with electronic medical records Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) Proficiency with the use of mobile technology (Smartphone, wireless laptop, etc.) Additional Information Requisition ID: 1000002875 Hiring Range: $68,040-$118,800 Read Less

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