POSITION SUMMARY/RESPONSIBILITIES
Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of resources, cost and quality of health care for members; coordinating care between the primary care physician, community resources, family and member; coordinating care across the health care continuum while monitoring and managing benefit utilization; and, collaborating with multi-disciplinary health care team members in identifying the educational and discharge needs of members.
EDUCATION/EXPERIENCE
Registered Nurse (RN) is required. Bachelor of Science in Nursing (BSN) or Master’s degree is preferred. Minimum three (3) years nursing, acute care, quality management or managed care experience is required. Basic knowledge of Medicaid, Medicare, community resources and alternate funding programs is desired. Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred.
LICENSURE/CERTIFICATION
Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. Current certification from an appropriate professional agency, such as Case Management Society, is preferred.
...Position Overview: We are seeking a motivated and detail-oriented Office Assistant to join our construction team. We are looking for... ...smooth office operations. Qualifications: No prior industry experience required. Basic familiarity with Microsoft Excel. Strong...
...Rooms To Go is hiring a Payroll Specialist in Seffner, Florida. The role involves full-cycle payroll processing, including compliance with federal and state regulations, handling payroll inquiries, and managing time and attendance data. Ideal candidates have over 2 years...
...Medical Receptionist Bay State Physical Therapy, a leading provider of outpatient physical therapy in the Northeast, is seeking a Medical Receptionist to join our team. Part time hours available - afternoons 1:00PM - 6:00PM Salary: $20 - $21/Hour What You'll Do...
A dynamic remote work company is seeking data entry clerks who can work from home. Applicants must have a stable internet connection and typing skills of at least 30 words per minute. The flexible pay ranges from $16 to $30 per hour based on experience. This position is...
...Paragon Pharma is seeking an enthusiastic Pharmaceutical Sales Representative (entry level and/or specialty) to educate physicians and other healthcare providers about our products, and to manage a territory with a patient-focused approach. You will drive sales while...