This position manages client accounts to ensure service satisfaction and retention of existing contracts. Serves as the clinical and operation liaison for Health Plan(s). Provides orientation / training to CareCentrix and Health Plan personnel, referral sources and network providers. Manages Quality Assurance, Utilization Management and Risk Management for client(s) to ensure retention and satisfaction. Supervises Clinical Account Manager (s) and Liaison(s) as needed.
This position requires excellent management, communication, presentation, and analytical skills, as well, as negotiating and decision making abilities.
- Abides by and demonstrates the company Mission–Vision–Values through both behavior and job performance on a day-to-day basis.
- Serves as direct manager for assigned Client Services Managers and Liaisons.
- Provides support for, and in the absence of, the AVP of Client Services day to day operations for the entire Client Services Team.
- Operationalizes contractual terms and ancillary information / processes (i.e. contact names, QA / QI process, risk management programs, utilization management / case management guidelines, plan picks, plan product information, etc.) for assigned accounts.
- Works with business development, implementation and account management to facilitate member transition for assigned accounts.
- Is cross-trained in implementation practices in order to facilitate new / expanded business for assigned accounts as needed.
- Partners with CareCentrix Operations, Clinical Management, Account Management, Quality and Provider Network Operations to ensure quality complaint / claims, resolution, utilization management and compliance / regulatory standards are achieved.
- Participates in and contributes to performance improvement activities.
- Adheres to and participates in the Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. Ensures Utilization and URAC standards followed.
- Assists in implementing and maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.
- Reviews and adheres to all Company policies and procedures and the Employee Handbook.
- Participates in special projects and performs other duties as assigned.
Must be able to interact with all levels of management and a diverse clientele, possess strong organizational skills and effectively prioritize and manage tasks.
Must be able to perform each essential duty satisfactorily and to work under minimal supervision.
Successful candidate must possess a current RN license, be able to practice without restriction.
BS Degree required
Minimum of two years experience in a managed care environment.
Additional experience in home healthcare, business and / or management preferred.
Computer skills required.
May require up to 40% travel based on assigned responsibilities.
Knowledge of Utilization Management and URAC standards.
CareCentrix - 20 months ago