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LVN Next Step Coordinator (San Jose)
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- Assist in obtaining additional records or reports for the initial file review and medication reconciliation. Assist in obtaining payment history and current status of the claim.
- Review all Next Step referral forms for completion with the direction and goals from the carrier or applicable parties.
- Assist the administrative coordinator on the receipt of medical records and timeframe for receipt of records.
- Update all applicable parties as to receipt of referral, medical records, direction, updates and status of the case within the Next Step program timeframes.
- Review the cost savings analysis and projected cost savings as well as assisting in the preparation of final cost savings and success stories.
- Coordinate physicians, nurses, defense attorneys, adjusters, claims managers, consultants, and any additional applicable parties for round table discussions, file reviews, recommendations, weekly updates, letters, documents needed as well as other duties on a case by case basis.
- Schedule, coordinate and implement all peer-to-peer telephonic meetings and round table discussions.
- Responsible for ensuring that the EK physician is on the call and prepared with the plan of action for the peer-to-peer conversation and recommendations on round tables. Notes are to be taken on the peer to peer teleconferences which will then be put into a letter to the PTP after review and editing by the specialty reviewer and/or the CMO.
- Ensure that all documents are uploaded to the case and sent out to all applicable parties.
- Enter all notes into the case on Ahshay as to all activities that are done on a weekly basis or more defined by the program coordinator’s activities, which include but are not limited to round table discussions and peer to peer teleconferences and/or letters.
- Assist in all documentation and enter or check all billings including physician time on round table discussions and peer to peers. Obtain monthly revenue reports and update applicable client reports to ensure that the level pricing stays within the signed perimeters. If above the authorized costs, contact the applicable party to obtain additional authorization on the level for costs.
- Other duties as assigned
LVN Case Management Coordinator (San Jose)
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- Access cases for medical case management and clinical consultation
- Provide accurate information to callers based on customer requests; triaging telephone calls to direct the caller for clinical consultation and for case managers
- Enter new claims data into the claims management system accurately; maintains data integrity in scanning, uploading, indexing and data entry
- Obtain required medical records as needed
- Support clinical staff through the completion of components of case management, including but not limited to appointment scheduling, diagnostic test scheduling, requesting medical records, faxing materials, mailing/e-mailing already identified education materials, scheduling delivery of already negotiated and approved DME, and facilitating claims adjudication
- Gather statistics for record keeping and provide reports as required
- Professional interaction with Nurses, Insurance Adjusters and other medical professionals
Upload dictation and enter billing items
- Assist with process, product and technology improvement projects
- Provide administrative support to Senior Case Manager/CEO as requested
- Perform inter-departmental administrative support as needed
Interpretation Coordinator (San Jose)
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- Promptly answer all incoming interpretation requests and assist callers with proper telephone etiquette; must sound professional, credible, pleasant, and sincere
- Recruit and assign interpreters to cases, confirm their appointments, and follow-up on their attendance
- Professional interaction with Interpreters, clients, medical offices, and all other callers
- Responds to routine inquiries or complaints from customers and the public; refers non-routine, sensitive and/or complex requests for information and other inquiries or complaints to appropriate staff
- Work with Department Managers to ensure customer satisfaction
- Other duties as assigned
Work Comp UR Triage Supervisor (Los Angeles)
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-Triage all treatment requests to determine that it is actually a referral, and what process the referral will take
-Use claims system to check for past treatment, confirmation of important information, and other factors that affect treatment (use of two different web-based systems daily)
-Supervise clinical & non-clinical staff including the direct performance management, evaluation, and training of employees, under the direction of the UR Manager
-Delegate & reassign responsibilities to ensure no staff member is overloaded or under-utilized
-Write, implement, update, and hold staff accountable to operational policies and procedures
-Ensure that all UR regulations are followed and timelines are met daily, assisting UR Manager as needed
- Promptly respond to client questions; must sound professional, credible, pleasant, and sincere
- Professional interaction with Nurses, Insurance Adjusters, and other medical professionals
Field Case Manager (San Jose, CA)
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- Attend appointments with injured workers to assist with coordination of care
- Act as a liaison between the injured worker, claims adjuster, treating physician, etc with the goal of return to work
- Professional interaction with EKHS staff, members of the medical community, and all customers of EKHS; both in oral and written forms
- All work is done within the scope of practice for a Registered Nurse in California
- Participate in EKHS Nursing teleconferences and staff meetings as scheduled.
Field Case Manager Per Diem/ Full-time(Fresno/ Modesto, CA)
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- Attend appointments with injured workers to assist with coordination of care
- Act as a liaison between the injured worker, claims adjuster, treating physician, etc with the goal of return to work
- Professional interaction with EKHS staff, members of the medical community, and all customers of EKHS; both in oral and written forms
- All work is done within the scope of practice for a Registered Nurse in California
- Participate in EKHS Nursing teleconferences and staff meetings as scheduled.
Data Analyst (San Jose)
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- Conduct data analysis pertaining to all processes, procedures, and results in different departments for client analytics, workflow streamlining and operational efficiency
- Analyze data for meaning, and communicate results to the appropriate parties within our business context
- Help facilitate a "think tank" in specific business units to ensure we are meeting industry and regulatory compliance & standards
- Assist in implementation of process improvements suggested from analysis results
- Assist in development of new programs and service offerings based on analyzed results to meet client needs
- Establish standardized list of daily, monthly, quarterly and annual reports for internal and external usage; designed based on quality performance and program performance expectations
- Occasional travel may be required
Per-Diem Field Case Manager (Sacramento, CA)
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- Attend appointments with injured workers to assist with coordination of care
- Act as a liaison between the injured worker, claims adjuster, treating physician, etc with the goal of return to work
- Professional interaction with EKHS staff, members of the medical community, and all customers of EKHS; both in oral and written forms
- All work is done within the scope of practice for a Registered Nurse in California
- Participate in EKHS Nursing teleconferences and staff meetings as scheduled.
Competitive Pay & Benefits, including Medical, Dental, Vision, 401(k), PTO, and more.
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