Health Plan Coordinator (FT) PACE

Company: Valir Health
Location: Oklahoma City
Posted on: May 23, 2020

Job Description:

Responsible for the development and implementation of a program for continuous monitoring of utilization of internal and external services, creating authorizations for services, and coordinating all service delivery requests, appeals, and grievances within all applicable regulations including CMS and state regulation and while achieving participant health outcome and organizational financial goals.QualificationsPOSITION REQUIREMENTS:License or Certification:----Total Education, Vocational Training, and Experience:-- At least 1-year prior experience specifically in in a healthcare related field with strong medical terminology and strong excel skills.-- At least 1-year experience working with a frail, elder population.----Skills and Abilities:Ability to set priorities, possess good organizational and communication skills;Ability to type 40-60 wpm;Strong Excel, Word, and Outlook skills;Possess good judgment, tact and ability to work effectively under stressful conditions;Self reliance;Ability to take initiative and be self-motivated.--PROTECTED HEALTH INFORMATION:Position has Limited Access to Protected Health Information of participants on caseload.--------Proficiency or Productivity Standards:Organize and prioritize tasks and projectsAccurately complete job responsibilities within the specified time constraints to meet the needs of patients, regulatory standards and customer satisfaction--Physical ReQUIREMENTS:Ability to read, speak, and hear"Exceptional attendance is a requirement in order to fulfill role expectations"Job performance can affect the safety of employee and others thus the job is considered safety sensitive--CRITICAL DEMANDS:Lift up to 25# from floor to 36" and from 36" to 64" (Occasional)---------------------- Sitting(Constant)Walk up to .25 miles(Occasional)------------------------------------------------------------------------------------------------------------------------------ Stand(Occasional)Sustained forward bending in sitting(Occasional)---------------------------------------------------------------------------- Repetitive Squat(Occasional)Push/Pull up to 75#of force at 36"(Occasional)---------------------------------------------------------------------------------- Kneel(Occasional)Repetitive Squat(Occasional)-------------------------------------------------------- ----------------------------------------------------------------------------------Full body range of motion(Constant)Grasp of various sizes and weights up to 50#(Constant)---------------------------------------------------------- Sustained squat(Occasional)Balance(Continuous) In walking, standing, carrying, moving patients, and equipment, etc.----Working Conditions:--Adult Day Care rooms, common areas, clinical departments and hospital grounds. Potential hazards include:Exposure to None Some Frequent Very Frequent Exposure to None Some Frequent Very Frequent* toxic/caustic chemicals -- ------ X -- -- *blood or body fluids ---- X -- -- --*extreme conditions, hot or cold -- X -- -- -- *communicable diseases -- -------- X -- --*dust/fumes/gases (including asbestos) -- X -- -- -- *unprotected heights --X -- -- --*moving mechanical parts ------ X -- -- -- *CRT (computer) monitor -- -- ------------ X --*potential electric shock ------ X -- -- -- *frequent, repetitive motions -- ------ X -- --*x-ray electro-magnetic energy ------ X -- -- -- *Other (as listed) -- -- -- --*high pitched noises ------ X -- -- -- -- -- -- -- --*needles or other sharp objects ------ X

Keywords: Valir Health, Oklahoma City , Health Plan Coordinator (FT) PACE, Healthcare , Oklahoma City, Oklahoma