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Job Description: Office Assistant Office Assistant Location: Tampa, FL Salary:  Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1008083       About the Opportunity A hospital in Florida is looking to fill an immediate need with the addition of a new Office Assistant to their growing OB/GYN Department. In this role, the Office Assistant will be responsible for providing administrative and clerical support to members of the office as needed. Company Description Hospital Job Description The Office Assistant will be responsible for: Insurance verification Taking co-pays Being the right hand person for the doctor on hand Other duties as needed Required Skills 1+ year of experience in a Front Desk or Receptionist role within a Medical Office Computer savvy Microsoft Office/Suite proficient Sold time management and problem solving skills Exceptional phone etiquette Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

Job Description: Office Assistant Office Assistant Location: Miami, FL Salary:  Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1008082       About the Opportunity A hospital in Florida is looking to fill an immediate need with the addition of a new Office Assistant to their growing staff. In this role, the Office Assistant will be responsible for providing administrative and clerical support to members of the office as needed. Company Description Hospital Job Description The Office Assistant will be responsible for: Insurance verification Taking co-pays Being the right hand person for the doctor on hand Other duties as needed Required Skills 1+ year of experience in a Front Desk or Receptionist role within a Medical Office Computer savvy Microsoft Office/Suite proficient Sold time management and problem solving skills Exceptional phone etiquette Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

Job Description: Medical Office Assistant Medical Office Assistant Location: Worcester, MA Salary:  Experience: 1. year(s) Job Type: Temporary / Consulting Job ID: U1014998       About the Opportunity A hospital in Massachusetts is currently seeking a versatile and hardworking Medical Office Assistant for a promising opportunity with their growing team of professionals. In this role, the Medical Office Assistant will be responsible for providing clinical and clerical support to the Urology Department of the facility. Apply today! Company Description Hospital Job Description The Medical Office Assistant will be responsible for: Assisting with procedures Documentation in the EMR Chart preparation Scanning and faxing of secure medical records Patient interaction, both on the phone and in person Performing vitals Medication reconciliation and supporting documents Submitting prior authorizations for prescriptions and medical equipment and supplies Placing Foley catheters and suprapubic catheters Urine testing by dia nd  processing specimens to send to lab. Required Skills 1+ year of Administrative experience in a Medical Facility or a related area; 1+ year of Customer Service experience High School Diploma / GED Computer savvy Microsoft Office/Suite proficient Solid problem solving and time management skills Exceptional phone etiquette Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

Job Description: Office Nurse (RN) - Cardiology Office Nurse (RN) - Cardiology Location: Springfield, NJ Salary: $30-$33 per hour Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1008190       About the Opportunity A healthcare practice in New Jersey is currently seeking a licensed Registered Nurse (RN) for a promising Office position working with their Cardiology patients. In this role, the Office Nurse (RN) will be responsible for providing evidence-based care to Adult Cardiology patients within the practice. Apply today! Company Description Healthcare Practice Job Description The Office Nurse (RN) will: Perform history and physical exams, order and monitor medications and treatments for efficacy or possible side effects, order laboratory and other diagnostic tests within the New Jersey Scope of Practice Follow up with the results of tests, communicate and consult with collaborating physicians as needed as per collaborative practice agreement Communicate with collaborating physician on a regular basis via e-mail and telephone Work with outside medical specialists to ensure coordinated care Consult with patients and families regarding goals of care; manage / supervise patients undergoing cardiovascular stress testing Serve as a leader, mentor, preceptor, and colleague to the nursing community within the organization Required Skills 2+ years of Clinical experience Graduate of an accredited Nursing program NJ Registered Nurse (RN) license BLS and ACLS certification Solid assessment, clinical and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively Desired Skills Interventional / Cardiothoracic / Cardiovascular experience

Job Description: Medical Management Specialist Medical Management Specialist Location: Iselin, NJ Salary: $20-$21 per hour Experience: 1. year(s) Job Type: Temporary / Consulting Job ID: U1010301       About the Opportunity A health insurance company in New Jersey is looking to fill an immediate need with the addition of a new Medical Management Specialist to their staff. 08830In this role, the Medical Management Specialist will be responsible for providing nonclinical support to the Medical Management and/or Operations areas. Apply today! Company Description Health Insurance Company Job Description The Medical Management Specialist: Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review) Provides information regarding network providers or general program information when requested Reviews and assists with complex case Acts as liaison between Medical Management and/or Operations and Internal Departments Required Skills 1+ year of experience with an understanding of Managed Care or Medicare High School Diploma Microsoft Office/Suite proficient (Excel, Outlook, Word, etc.) Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively Desired Skills Previous experience in Macess, Facets or Care Compass Familiarity with Medical terminology

Job Description: Nazareth Hospital, Mercy Health System The mission of Mercy Health System is to participate in the healing ministry of its sponsor, the Sisters of Mercy, and the Roman Catholic Church. This mission is at the service of the entire community and addresses the diversified factors which impact the health care needs of the whole person. The mission is characterized by a special concern for the poor and disadvantaged. Mercy Health System is dedicated to providing easily accessible, patient-centered, compassionate health care. Building on our 100 year foundation of caring, we achieve our mission through our commitment to the overall health of the communities we serve. Our centers of health care excellence address the unique and diverse needs of these communities. Rooted in our core values, Mercy Health System, its facilities and affiliates offer access to quality medical care, delivered by compassionate, highly trained health care professionals to all in need. If you are an individual who is mission driven and who wants to make a difference in the lives of others, we invite you to join us. We know our colleagues are our core strength and that each contributes to our ministry of quality and compassionate care. As a Mercy colleague you will have a great working environment, career growth, competitive benefits, and support for involvement in your community.  Job Description Under the general supervision of the Director of Care Coordination, the Emergency Department Care Manager assists physicians and the interdisciplinary team in facilitating the entry of patients into the appropriate level of care by utilizing InterQual criteria. Reduces unnecessary admissions to the acute care hospital. Has accountability for assigning correct levels of care (Outpatient Observation vs. Inpatient Admission), attention to the issues presented by readmissions and recommending options for safe discharge. Coordinates all non-elective point of entry admissions (including direct admissions and SPU) and facilitates timely throughput of emergency room patients to ensure the safe delivery of services to the patient at the most appropriate level of care. Responsible for identifying community and other resources that are necessary for each individual patient and matches specific needs for continued care that are acceptable to the patient. Identifies services that require authorization and collaborates with payers to obtain needed authorizations for services. Ensures patient has a primary care physician follow-up. Collaborates with the ED healthcare team to determine the treatment plan, while observing quality and patient safety parameters, LOS, readmissions, denials and appeals.   Education and Training BSN or BA in Nursing. Enrolled or committed to enroll in a BSN or BA in Nursing program, making steady progress towards degree. Certification and Licensure Registered Nurse licensed in the State of Pennsylvania Case Management certification from an accredited organization preferred.   Skills • Managed care, government payers, third-party reimbursement • InterQual criteria and its application • Information systems, Midas preferred • Using MS Office applications • Developing and maintaining strong interpersonal relationships • Oral and written communication skills • Ability to document in an electronic health record completely and accurately  Experience Three (3) years of utilization management or case management experience, including emphasis on discharge planning.   Apply directly on line at: https://trinityhealth.wd1.myworkdayjobs.com/Nursing_Jobs/job/Philadelphia-Pennsylvania/XMLNAME-2000-T1005-RN-ED-CARE-MANAGER_00033311-1   A policy of Equal Employment Opportunity is maintained within all institutions. This policy is based on the right of all persons to work and to advance in their work on their own merit, ability and potential. This policy involves all persons regardless of race, color, religion, age, sex, sexual preference, national origin, veteran status, political affiliation, or handicap.

Job Description: HEDIS Abstractor (RHIA / Coder) HEDIS Abstractor (RHIA / Coder) Location: Iselin, NJ Salary:  Experience: 1. year(s) Job Type: Temporary / Consulting Job ID: U1016591       About the Opportunity A New Jersey-based healthcare company is looking to fill an immediate need with the addition of a new HEDIS Abstractor (RHIA / Coder) to their growing staff. In this role, the HEDIS Abstractor (RHIA / Coder) will be responsible for determining appropriate codes for medical services and procedures to ensure accurate adjudication of claims as well as working with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base. Apply today! Company Description Healthcare Company Job Description The HEDIS Abstractor (RHIA / Coder) will be responsible for: Reviewing operative notes and various forms and medical records to identify proper coding of claims Providing training and guidance to service operations staff to ensure accurate claims adjudication and explanation of benefits Reviewing denied claims and advises service staff regarding appeals Maintaining current knowledge of coding and keeps current with medical compliance and reimbursement policies impacting claims payment Required Skills 1+ year of related work experience High School Diploma / GED Certified Professional Coder (CPC) with designation from an accredited source such as American Health Information Management Association, American Academy of Professional Coders, or Practice Management Institute Understanding of codes for services based on diagnosis and procedure Working knowledge of Medical Records Microsoft Office/Suite proficient (Excel, Outlook, Word, etc.) Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Associate's and/or Bachelor's Degree in a related field Prior HEDIS experience RHIA certification

Job Description: HEDIS Abstractor (RHIA / Coder) HEDIS Abstractor (RHIA / Coder) Location: Iselin, NJ Salary:  Experience: 1. year(s) Job Type: Temporary / Consulting Job ID: U1014179       About the Opportunity A healthcare company in New Jersey is looking to fill an immediate need with the addition of a new HEDIS Abstractor (RHIA / Coder) to their growing staff. In this role, the HEDIS Abstractor (RHIA / Coder) will be responsible for determining appropriate codes for medical services and procedures to ensure accurate adjudication of claims as well as working with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base. Apply today! Company Description Healthcare Company Job Description The HEDIS Abstractor (RHIA / Coder) will be responsible for: Reviewing operative notes and various forms and medical records to identify proper coding of claims Providing training and guidance to service operations staff to ensure accurate claims adjudication and explanation of benefits Reviewing denied claims and advises service staff regarding appeals Maintaining current knowledge of coding and keeps current with medical compliance and reimbursement policies impacting claims payment Required Skills 1+ year of related work experience High School Diploma / GED Certified Professional Coder (CPC) with designation from an accredited source such as American Health Information Management Association, American Academy of Professional Coders, or Practice Management Institute Understanding of codes for services based on diagnosis and procedure Working knowledge of Medical Records Microsoft Office/Suite proficient (Excel, Outlook, Word, etc.) Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Associate's and/or Bachelor's Degree in a related field Prior HEDIS experience RHIA certification

Job Description: Care Manager (LPN / LSW / LCSW) Care Manager (LPN / LSW / LCSW) Location: New York, NY Salary: $37,000-$40,000 Experience: 3. year(s) Job Type: Full-Time Job ID: J137390       About the Opportunity A medical facility in New York City is currently seeking a licensed medical professional to join their growing staff as a new Care Manager. Under the supervision of the Care Management Team Leader, the Care Manager (LPN / LSW / LCSW) will be responsible for providing direct care management services to clients living with HIV / AIDS, chronic diseases, substance use, and/or mental illnesses. Apply today! Company Description Medical Facility Job Description The Care Manager will: Identify and recruit the chronic disease population, including HIV/AIDS, mentally ill and substance users, to facilitate early access to treatment and social services to establish a caseload of 60-100 Initiate and coordinate the implementation of the comprehensive care plan Coordinate and oversee services between patent and extended care team providers to ensure that integrated care plan is fully implemented Conduct data entry to program related portal Write and submit monthly services reports in a timely manner Conduct case finding and engagement of new referrals and lost to care clients Perform regular home visits to assess clients' living environments to ensure appropriate living situation Maintain client-related records and other required documentation according to the protocols and standards of the Support Services Department Required Skills 3+ years of related work experience Bachelor's Degree in Nursing, Social Work, Social Science, and/or Psychology NYS Licensed Practical Nurse (LPN), Licensed Social Worker (LSW), and/or Licensed Clinical Social Worker (LCSW) Experience in working with one of the following communities: HIV/AIDS; substance user; mentally ill; and Lesbian, Gay and Transgender (LGT) Microsoft Office/Suite proficient Solid assessment, clinical, and documentation skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

Job Description: Practice Manager Practice Manager Location: Port Jefferson, NY Salary:  Experience: 5.0 year(s) Job Type: Temporary / Consulting Job ID: U1015985       About the Opportunity A medical practice on Long Island is actively seeking an experienced professional to join their growing staff as their new Practice Manager. In this role, the Practice Manager will be responsible for performing a wide variety of clerical and administrative duties for the practice. Apply today! Company Description Medical Practice Job Description The Practice Manager will be responsible for: Providing a high level of customer service and support Consistently producing an excellent work product Responding to requests in a professional manner Identifying and responding to issues in a timely manner Seeking feedback / following-up, as appropriate Building effective working relationships Required Skills 5+ years of experience managing a Multi-Physician Practice Associate's and/or Bachelor's Degree in a related field Previous experience in a Supervisory and/or Leadership role Knowledge of PCMH, DSRIP and MACRA Computer savvy Microsoft Office/Suite proficient Solid problem solving and time management skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized

Job Description: Case Manager Case Manager Location: Bronx, NY Salary:  Experience: 2. year(s) Job Type: Temporary / Consulting Job ID: U1004376       About the Opportunity A nonprofit organization in New York City is looking to fill an immediate need with the addition of new Case Manager to their staff. In this role, the Case Manager will be responsible for promoting client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation.  Company Description Nonprofit Organization Job Description The Case Manager will: Represent the organization's mission, values, ethics, and uphold agency Code of Conduct, at all times Link clients with appropriate providers and resources throughout the continuum of health and human services and care settings based on the needs and values of the client Escort clients to scheduled and unscheduled psychiatric/medical care Ensure that clients receive safe, effective, client-centered, timely, efficient, and equitable care Organize, facilitate, and escort as needed for on/off-site activities in addition to managing a minimum of two ongoing groups Track client participation in the client record Conduct unit inspections and ensure proper follow-up to findings, assisting clients as needed Maintain client records as "audit-ready" at all times, as required by program funding sources Required Skills 2+ years of experience in a Human Services role Bachelor's Degree (social services field preferred) Working knowledge of issues related to homelessness, HIV, substance abuse, mental illness, and entitlements Crisis intervention skills Solid time management and problem solving skills Microsoft Office/Suite proficient Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Degree in Social Services

Job Description: Inpatient Certified Medical Coder Inpatient Certified Medical Coder Location: New York, NY Salary:  Experience: 2. year(s) Job Type: Temporary / Consulting Job ID: U1014134       About the Opportunity The Health Information Management Department of a recognized medical facility in New York City is currently seeking a new Inpatient Certified Medical Coder for a promising position with their growing staff. This is a great opportunity for a diligent and dedicated Inpatient Certified Medical Coder to gain valuable work experience and further their career at an established facility in Manhattan. Apply today! Company Description Medical Facility Job Description The Inpatient Certified Medical Coder will be responsible for medical coding and researching coding related issues in an acute care setting. Required Skills 2+ years of Coding experience in a Hospital setting High School Diploma / GED RHIT / RHIA, CCS, AHIMA or CCP certification Knowledge of Coding guidelines, Payor guidelines, Federal Billing guidelines Knowledge of Anatomy, Physiology & Disease processes Knowledge of ICD-10 Knowledge of Medical terminology Knowledgeable of 3M database Microsoft Office/Suite proficient (Excel, Word, etc.) Solid analytical skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized

Job Description: Case Management Nurse Manager (RN) Case Management Nurse Manager (RN) Location: New York, NY Salary: $81,000-$86,000 Experience: 0.0 year(s) Job Type: Full-Time Job ID: J130854       About the Opportunity A New York City healthcare organization is currently seeking a licensed Registered Nurse (RN), with a strong Case Management background, for a promising Managerial position with their growing staff. In this role, the Case Management Nurse Manager (RN) will be responsible for effectively managing the daily operations / workflow and supervising clinical and non-clinical staff to provide support for the organization's Care Management programs. Company Description Healthcare Organization Job Description The Case Management Nurse Manager (RN) will be responsible for: Assisting in developing strategic plan by partnering with Assistant Director and Fund management to identify opportunities that have direct impact on clinical and financial outcomes Accessing and analyzing all processes on an ongoing basis to determine their effectiveness, eliminate inefficiencies and make recommendations to senior management to improve workflow, operations, and staff performance Coordinating activities between clinical programs, communication, and report requirements to maintain operational efficiencies and to be in compliance with the Department of Labor (DOL), Summary Plan Description (SPD) departmental protocols and clinical policies and procedures Interacting and collaborating with other departments (e.g. Claims and Provider Relations) in troubleshooting, problem solving, and exchanging information in conjunction with maintaining effective communication with providers and members Staff development, clinical orientation, ongoing education, and training programs to meet the changing needs of the Department Continually assessing clinical staff performance against internal and external departmental and industry standards Required Skills 5+ years of Advanced or Specialized work experience in Care Management programs (Utilization / Case Management / Appeals Programs) within a Managed Care organization; 2+ years of progressive Leadership and Management experience Bachelor’s Degree in Nursing, Business or Health Care Administration or equivalent years of work experience required; plus Current NYS Registered Nurse (RN) license Working knowledge of Milliman / InterQual guidelines or other regulatory protocols (i.e. Medicare), claims processing, medical coding (ICD-9, HCPCS, CPT) and interpreting provider contracts Strong Medical / Clinical background Microsoft Office/Suite proficient Solid critical thinking and analytical skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized $ Desired Skills Previous management experience and CCM certification

Job Description: Care Manager (RN) Care Manager (RN) Location: Newark, NJ Salary: $34-$42 per hour Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1012190       About the Opportunity A healthcare company in New Jersey is actively seeking a licensed Registered Nurse (RN) for a promising Care Manager position with their growing medical staff. In this role, the Care Manager (RN) will be responsible for coordinating the care and services of Long Term Care members across the continuum of illness. Apply today! Company Description Healthcare Company Job Description The Care Manager (RN) will: Assess short-term and long-term needs and establish case management objectives Manage 75 to 100 active cases based on case intensity and acuity Handle Utilization Management and use prescribed criteria to provide timely, appropriate, and medically necessary service authorizations Interact continuously with member, family, Physician(s), IDT members, and other providers to utilize clinical knowledge and expertise to determine medical history and current status Assess the options for care, including use of benefits and community resources Act as liaison and member advocate between the member/family, Physician and facilities / agencies Coordinate community resources with emphasis on medical, behavioral, and social services Required Skills 2+ years of experience in a Clinical Acute Care position; 1+ year of experience in Care / Case Management Associate's Degree in Nursing NYS Registered Nurse (RN) license Microsoft Office/Suite proficient (Excel. Word and Outlook) Solid assessment, clinical, and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Bachelor's Degree in Nursing Certified Case Manager (CCM) Previous experience in Home Health, Physician's office or Public Health setting

Job Description: Case Manager (RN) Case Manager (RN) Location: Piscataway, NJ Salary: $30-$33 per hour Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1011128       About the Opportunity A respected healthcare facility located in Piscataway, NJ is actively seeking a self-motivated and patient-oriented Registered Nurse (RN) for a promising opportunity on their staff as a Case Manager. In this role, the Case Manager will be responsible for reviewing multiple reporting sources to identify and engage members/patients for case management services. Apply today! Company Description Healthcare Facility Job Description The Case Manager (RN) will: Establish and maintain communications with attending physicians, discharge planner and social worker during patients hospital stay Coordinate discharge needs and facilitate alternative level of care Maintain ongoing communication with the attending physician and ancillary providers regarding the patients needs Document clinical information into Medical Management system Attend Team Meetings and Case Management meetings on a weekly basis Review requests for specialty services and direct In Network when available Communicate Network negotiations to Provider Services Notification of Re-Insurance cases Perform prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient Required Skills 2-4 years of previous Case Management experience in Managed Care 2 years of Medical-Surgical experience Active New Jersey State Registered Nurse license QC Medical Management systems experience Strong medical skills and knowledge Proficient in Microsoft Office programs

Job Description: Care Manager (RN) Care Manager (RN) Location: Newark, NJ Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1014505       About the Opportunity A compassionate and driven Registered Nurse (RN) is currently being sought out by a well-known managed care company in Newark for a promising opportunity on their staff as a Care Manager. In this role, the Care Manager coordinates the care and services of Long-Term Care members across the continuum of illness services Apply today! Company Description Managed Care Company Job Description The Care Manager (RN): Assesses short-term and long-term needs and establishes case management objectives Manages 75 to 100 active cases based on case intensity and acuity Oversees Utilization Management and uses prescribed criteria to provide timely, appropriate, and medically necessary service authorizations Interacts continuously with member,  family, physician(s), IDT members,  and other providers Assesses the options for care Acts as liaison and member advocate Coordinates community resources with emphasis on medical, behavioral, and social services Applies care management standards and maintains HIPAA standards Reports critical incidents and information regarding quality of care issues Required Skills Active New Jersey State Registered Nurse license 2+ years of experience in a clinical acute care position(s) 2+ years of case management experience 1+ year of experience in care/case BSN Ability to drive multiple projects Ability to multitask Healthcare Management Systems (Generic)  knowledge Proficient in Microsoft Office, particularly Excel Desired Skills Certified Case Manager Experience in in home health, physician’s office or public health Bilingual skills

Job Description: Managed Care Coordinator Managed Care Coordinator Location: Trenton, NJ Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1005564       About the Opportunity A widely recognized healthcare organization in Trenton, NJ is actively seeking a driven and patient-oriented healthcare professional for a promising opportunity on their staff as a Managed Care Coordinator. In this role, the Managed Care Coordinator supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Company Description Healthcare Organization Job Description The Managed Care Coordinator: Performs review of service requests Handles initial screening for pre-certification requests from physicians/members  Prepares, documents and routes cases in appropriate system for clinical review Initiates call backs and correspondence to members and providers to coordinate and clarify benefits Initiates call back or correspondence to Physicians/Members  Reviews professional medical/claim policy related issues or claims in pending status Required Skills High School Diploma Polished and professional demeanor Ability to multitask Proficient in Microsoft Office Knowledge of medical terminology Strong verbal and written communication skills Demonstrated analytical skills Highly organized Desired Skills Bachelor's Degree 1-2 years of customer service or medical support-related experience Knowledge of contracts, enrollment, billing and claims coding/processing Knowledge of Managed Care principles Ability to analyze and resolve problems with minimal supervision Ability to use a personal computer and applicable software and systems

Job Description: Managed Care Coordinator Managed Care Coordinator Location: Ewing, NJ Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1005418       About the Opportunity A widely recognized healthcare organization located in Ewing, NJ is actively seeking a self-motivated and dynamic professional for a promising opportunity on their staff as a Managed Care Coordinator. In this role, the Managed Care Coordinator supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Company Description Healthcare Organization Job Description The Managed Care Coordinator: Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients Handles initial screening for pre-certification requests from physicians/members Prepare, document and route cases in appropriate system for clinical review Initiates call backs and correspondence to members and providers to coordinate and clarify benefits Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion Reviews professional medical/claim policy related issues or claims in pending status Upon collection of clinical and non-clinical information, authorize services based upon scripts or algorithms used for pre-review screening Perform other relevant tasks as assigned by Management Required Skills High School Diploma Strong medical skills and knowledge Proficient in Microsoft Office Excellent written and verbal communication skills Ability to make sound decisions under the direction of Supervisor Strong analytical skills Demonstrated interpersonal skills Team-oriented Desired Skills 1-2 years of experience in a customer service or medical support-related position Knowledge of contracts, enrollment, billing and claims coding/processing Knowledge of Managed Care principles Ability to analyze and resolve problems with minimal supervision Ability to use a personal computer and applicable software and systems

Job Description: Care Manager (RN) Care Manager (RN) Location: Newark, NJ Salary:  Experience: 2. year(s) Job Type: Temporary / Consulting Job ID: U1015238       About the Opportunity A healthcare company in New Jersey has a promising Care Manager position awaiting a licensed Registered Nurse (RN) with their growing staff. In this role, the Care Manager (RN) will be responsible for coordinating the care and services of Long Term Care members across the continuum of illness,promoting effective utilization, and monitoring health care resources. Apply today! Company Description Healthcare Company Job Description The Care Manager (RN) will be responsible for: Managing 75 to 100 active cases based on case intensity and acuity Utilization Management and using prescribed criteria to provide timely appropriate and medically necessary service authorizations Assessing the options for care, including use of benefits and community resources in order to update the Person Centered Service Care Plan Acting as a liaison and member advocate between the member / Family Physician and facilities / agencies Maintaining accurate records of care management activities in the EMMA system using clinical guidelines Coordinating community resources with emphasis on medical behavioral and social services Applying care management standards and maintains HIPAA standards and confidentiality of protected health information Reporting critical incidents and information regarding quality of care issues Ensuring compliance with all State and Federal regulations and guidelines in day-to-day activities Participating in monthly chart audits Required Skills 2+ years of experience in a Clinical Acute Care position; 1+ year of experience in Care / Case Management Associate's Degree in Nursing NJ Registered Nurse (RN) license Solid assessment, clinical, and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Bachelor's Degree in Health Services and/or Nursing Certified Case Manager (CCM) Previous experience in a Home Health, Physician's Office, and/or Public Health setting Bilingual

Job Description: Network Management Representative Network Management Representative Location: Tampa, FL Salary:  Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1008101       About the Opportunity A Florida-based healthcare company is actively seeking a personable professional to join their staff as a Network Management Representative.  In this role, the Network Management Representative will be responsible for providing quality, accessible and comprehensive services to the company's provider community. Company Description Healthcare Company Job Description The Network Management Representative will: Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns Develops, maintains, and enhances relations with providers to foster cooperative business relationships Coordinates prompt claims resolution through direct contact with providers and claims department Provides assistance with policy interpretation Researches, analyzes and recommends resolution for provider disputes as well as issues with billing and other practices Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery Tracks customer service patterns/trends and identifies training when appropriate Drafts training documents and conduct provider refresher training at onsite provider locations or by telephone Researches issues that may impact future provider negotiations or jeopardize network retention Required Skills 1+ year of Customer Service experience High School Diploma Computer savvy Microsoft Office/Suite proficient Solid time management and problem solving skills Exceptional phone etiquette Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

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You’ve been in the medical administrative field for a long time. In fact, sometimes you think you know enough to run the place. So why don’t you?

Medical office managers make the medical office run smoothly.  Medical office manager jobs are a huge responsibility, because managers are in charge of organizing, monitoring, and controlling the business operations of the facility.

Office managers in the medical field are responsible for hiring, training and overseeing the administrative staff. They are the ones who establish and implement office policies and procedures. Office managers also interact heavily with patients as they oversee patient registrations, scheduling, and records, so strong customer service skills are needed.

There are some prerequisites to obtaining medical office manager positions. Applicants may need a Bachelor’s or Associate’s degree in a related field. Knowledge of medical coding and terminology is a must, and experience in administration is required. Many medical office managers have backgrounds in nursing, medical billing, or business administration. Still think you can run the place? Check out ADVANCE Healthcare Jobs to find medical office manager jobs in your area.