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Case Management Analyst
Ref No.: 19-07602
Location: Birmingham, Alabama
Case Management Analyst
 
Address: 2 Chase Corporate Drive, Suite 300, Hoover, AL 35244
Hours: Monday-Friday 8:00AM-5:00PM
Pay Rate: $27.55/hour paid every Friday
Contract Length: 12/09/2019 to 02/28/2020 (possible extension based on attendance and performance)
Openings: 1

Duties:
  • Responsibilities include collecting, analyzing, and evaluating clinical documentation received using established criteria to determine appropriateness of clinical decisions; Meet/exceed service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, Abandonment Rate);
  • Adherence to regulatory and departmental timeframes for review of requests received;
  • Collaborates with the Medical Director to identify utilization trends and generation of monthly written reports;
  • Process approval and adverse clinical determination correspondence for members related to Prospective request for services.
  • Initiate the letter of agreement process, working with Network Management to ensure Service Level Agreements are completed in a timely manner when applicable;
  • Proficient knowledge of Health Services policies and procedures, Medicare, HIPPA and NCQA standards;
  • Professional demeanor and the ability to work effectively within a team or independently;
  • Flexible with the ability to shift priorities when required;
  • Coordinates with member, family, and caregivers to help resolve barriers to care;
  • Successfully collaborates with member and family to assure comprehension of available resources;
  • May participate or assist in the planning of team, UM/QM, PCP, IPA and or Health Plan meetings.
  • Other duties as required
Skills and Education:
  • LPN, LVN, or RN with 1-3yrs experience in a Managed Care environment.
  • Valid Nursing License in the *** member areas or ability to obtain in a reasonable time period as established by the Director of Health Services or medical Director.
  • Working knowledge of medical coding (CPT/ICD-9) and medical necessity criteria (e.g., InterQual, Highmark, Trail Blazer)
  • A.S. or B.S.
  • Ability to pass 7-year county background check and urine drug screen