Available on provided telephonic platform, both taking and placing calls to coordinate care for members between facilities, hospitals, and Optum field colleagues Utilize EMR proficiently to provide acute care to members during overnight and weekend/ holiday hours Primary Care Delivery Deliver cost effective, quality care to members Manage both medical and behavioral, chro

Establish and maintain positive clinical rapport with patients and their families, working closely with them in the provision of infusion therapy, education related to self care and self administration, and clinical monitoring of patient response to therapy Assess patient appropriateness for home infusion therapy, including safety of the home environment, availability of

Clinical Knowledge and Skills Demonstrates clinical competence in the direct care of patients/significant others in established area of practice, considering developmental differences among patients Demonstrates basic knowledge of common disease processes and treatments, including pertinent diagnostic/laboratory testing and medical/nursing interventions; familiar with pre

Works in a hospital setting and builds solid relationships with patients, hospital staff, pharmacy team as well as other clients and stakeholders aligned with the business group Participates in daily/weekly/monthly team meetings and acts on feedback to ensure quality care on site Educates potential patients about services provided at time of discharge and articulates how

Identify appropriate assignment of CPT and ICD 10 Codes for outpatient Emergency Department services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Knowledge in Evaluation & Management, Infusion & Injection, Emergency Room Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity Edits Und

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Provide claims expertise support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities Analyze, identify trends and provide reports as necessary Ensure adherence to state and federal compliance policies, reimbursement policies and contract c

Respects confidentiality and is HIPAA compliant in all aspects of communication regarding patient, Practice and staff members Functions as a member of a team committed to quality patient care and takes initiative to keep informed of new/revised Policy and Procedures Completes Mandatory Education annually and attends/participates in training/review classes and projects as

Distributes drugs prescribed by physicians and other health practitioners Provides information to customers about medications and their use Focuses on providing a superior level of customer service Ensures compliance with all relevant laws of the applicable State Board of Pharmacy Administration of immunizations as allowed by State Boards of Pharmacy Any other usual and c

Establish and maintain positive clinical rapport with patients and their families, working closely with them in the provision of infusion therapy, education related to self care and self administration, and clinical monitoring of patient response to therapy Assess patient appropriateness for home infusion therapy, including safety of the home environment, availability of

Greets visitors and patients in person Communicates by telephone or video conferencing, upholding excellent customer service Handles confidential information appropriately by protecting and disclosing information to only those authorized Understands and follows all Switchboard departmental processes implemented Prioritizes by assessing and analyzing information to identif

Understand and follow standardized processes for managing add or change requests and implementing requests in the letter generation system Create and review denial letters to determine compliance with contractual and regulatory requirements of the State and Federal programs, while reviewing for efficiencies and effectiveness of procedures Performs internal Quality Control

Greets patients as they arrive and manage appropriate standard wait times Complete check in and check out tasks to include insurance verification, complete pre authorizations and/or precertification of procedures, and copy required documents Collects co payments, co insurance, and deductibles and issues receipts Processes walk in patients and visitors Answers phones and s

Distributes drugs prescribed by physicians and other health practitioners Provides information to consumers about medications and their use Focuses on providing a superior level of customer service. Ensures compliance with all relevant laws of the applicable State Board of Pharmacy Administration of immunizations as allowed by State Boards of Pharmacy Per Diem pharmacist

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For