Home Care Managed Care Coord- Remote

Discover Vanderbilt University Medical Center:  Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research.

Organization:

VHCS Admin - Support

Job Summary:

JOB SUMMARY
Collaborates with the home health care team to coordinate patient home care across the continuum of home care by requesting authorization for patient visits. Serves in an advocacy role on behalf of patients, families, and caregivers to ensure safe, equitable healthcare provision. Assists in developing and meeting key Pillar outcomes and system improvement goals including financial, satisfaction, and clinical as the Home Care Managed Care Coordinator.

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KEY RESPONSIBILITIES
• Request authorizations for Home Health Care from insurance carriers, through whatever method is optimal and the most efficient and effective for that carrier.
• Obtain Start of Care (SOC) authorization.
• Obtain Add-on prior authorization, obtain prior authorization for Resumption of Care (ROC), obtain concurrent authorization.
• Enter authorization request responses.
• Case Management Advocacy.
• Review written off no authorization (wona) requests from billing team for possible.
• Confer with other MCC's, brainstorm on any new payer process changes, and update Payer Auth Requirement document
• Review and respond to all messages from all staff including concurrent authorization requests/payer questions.
• Review and responds timely to all billing company communication through our “Jira” tool and effectively minimizes the outstanding “Jira” messages in their work que.
• Review and correct process errors from authorization Edit reports.
• Review validation report errors.
• Review and respond timely to Outlook messages and voice mail messages and review Outlook calendar reminders.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.
• Demonstrates leadership skills and acts as the key information and education resource for the interdisciplinary team as related to insurance authorization needs and securing appropriate services.
• Integrates ethical provisions in all areas of the practice.
• Deep dive analyses of insurance denials and authorization requests, using excel spreadsheet for data tracking.

TECHNICAL CAPABILITIES
• Data Analytics (Intermediate): Can analyze and interpret data to derive insight. Applies the appropriate approach to provide creative solutions for the given problem. May have working knowledge in business intelligence and analytics software [such as Tableau, Business Objects, Excel, and R].
• Managed Care Coordinators Management (Intermediate): Demonstrates mastery of insurance carrier authorization management in practical applications for Home Care clinical care coordination of visits. Possesses sufficient knowledge, training, and experience to be capable of successfully delivering results without requiring support and instruction from others. Able to train and educate by setting the example, giving instruction, providing leadership, and generally raising the level of performance of others while on the job.
• Authorization Evaluation (Intermediate): Possesses sufficient knowledge, training, and experience to role model and coach less experienced peers.
• Evidence Based Practice (INTERMEDIATE): Demonstrates ability to integrate evidence from multiple sources and determine if a practice change should occur. Shares knowledge with peers and other clinical team members independently.

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

* Organizational Impact: Performs tasks that are typically routine that may impact team's performance with occasional guidance. * Problem Solving/ Complexity of work: Utilizes some discretion and research to solve routine problems. * Breadth of Knowledge: Applies knowledge of standards, established processes and procedure that apply to your own job. * Team Interaction: Provides guidance to entry level co-workers.

Core Capabilities :

Supporting Colleagues : Develops Self and Others: Continuously improves own skills by identifying development opportunities.- Builds and Maintains Relationships: Seeks to understand colleagues' priorities, working styles and develops relationships across areas.- Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner. Delivering Excellent Services: - Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service.- Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner. - Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality: - Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards. - Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Managing Resources Effectively : - Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service. - Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources. - Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error. Fostering Innovation : - Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them. - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action. - Adapts to Change: Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work.

Position Qualifications:

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

5 years

Education:

Bachelor's

Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity.  EOE/Vets/Disabled.