Job Summary:

• Complete scheduling of peer reviews for all lines of business
• Building and verifying template information, making outbound/receiving inbound calls from facility
• Schedule, coordinate MD calendars, documenting in the cas
• Assigning for follow-up, updating a peer review tracker, and notifying Case Managers
• Provide verbal determination to facility on results of peer reviews
• Complete follow-up on cases after peer review including assisting with alternative level of care authorizations, discharge planning
• Making referrals to behavioral specialty case management programs
• Utilize workflows efficiently to ensure accurate documentation and adhere to compliance guidelines 
• Responsible for management of MD Scheduling mailbox
• Identifying issues and providing steps for resolutions
• Acting as a liaison between Case Managers and Federal Field Specialists
• Coordinating and conducting regular meetings and providing program status

Skills on Resume:

• Scheduling Management (Hard Skills)
• Effective Communication (Soft Skills)
• Accurate Documentation (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Case Coordination (Hard Skills)
• Referral Handling (Hard Skills)
• Problem Resolution (Soft Skills)
• Stakeholder Liaison (Soft Skills)

Job Summary:

• Develop and ensure that the program meets the participant's needs
• Assist designated program participants to understand the overall goals and programs being implemented
• Act as a liaison for families, along with staff, and provide them with information and resources
• Review the designated program participant's reports for consistency and coordination of goals
• Responsible for the development, coordination, carry-through of and follow-up on discharge planning
• Assist in internal communication with team members relative to case-specific issues.
• Prepare, write, and distribute communications related to applicable departmental needs
• Perform all required aspects of the Medicaid Process
• Attend meetings and provide training(s)/update and revise written documentation of procedure(s)
• Assist with planning and coordination of events and activities

Skills on Resume:

• Program Development (Hard Skills)
• Participant Support (Soft Skills)
• Family Liaison (Soft Skills)
• Report Review (Hard Skills)
• Discharge Planning (Hard Skills)
• Internal Communication (Soft Skills)
• Documentation Skills (Hard Skills)
• Event Coordination (Soft Skills)

Job Summary:

• Ability to work with managers, co-workers and panelists, sharing critical information to accomplish objectives
• Is present and punctual, prepared for work, is committed to fulfilling job responsibilities.
• Regularly produces accurate and timely work product, fulfilling all requirements of the position.
• Dedicated to neutrality, integrity, honesty, accountability, and mutual respect in all interactions
• Provides a supportive work environment for a diverse workforce.
• Makes sound decisions, bases decisions on fact rather than emotion, analyzes problems skillfully
• Makes constructive suggestions, prepares for problems or opportunities
• Undertakes additional responsibilities responds to situations as they arise with minimal supervision
• Reviewing and validating recommendations developed by Case Managers
• Requesting, gathering, and reviewing additional case information
• Conducting meetings and interviews with individuals and potential sponsors

Skills on Resume:

• Collaborative Teamwork (Soft Skills)
• Professional Reliability (Soft Skills)
• Timely Accuracy (Hard Skills)
• Ethical Integrity (Soft Skills)
• Diversity Support (Soft Skills)
• Analytical Decision-Making (Hard Skills)
• Proactive Initiative (Soft Skills)
• Effective Coordination (Soft Skills)

Job Summary:

• Assures the appropriate application of internal and external utilization review for hospital patients while still in the Emergency Department.
• Proactively review ED patient census to anticipate potential admissions/ observation patients.
• Collaborate with the ED nursing and physician teams to obtain any missing information necessary to complete medical necessity review.
• Collaborate with ED physician and / or attending provider to provide guidance on appropriate status and level of care based on medical necessity criteria and organizational standards prior to IP admission or OBS placement and bed request.
• Ensure documentation in the medical record is adequate to support status and level of care and discuss with ED physician and/or admitting physician 
• Complete medical necessity screening and provide input to ED attending and/or admitting physician prior to admission order placement and bed request.
• Maintains current knowledge of federal, state, hospital and TJC guidelines relating to medical and utilization management and quality improvement.
• Assist with coordination of activities that promote quality outcomes, patient throughput in the ED and discharge planning 
• Supporting a balance of optimal care and appropriate resource utilization.

Skills on Resume:

• Utilization Review (Hard Skills)
• Census Monitoring (Hard Skills)
• Collaborative Communication (Soft Skills)
• Medical Guidance (Hard Skills)
• Documentation Oversight (Hard Skills)
• Medical Screening (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Quality Coordination (Soft Skills)

Job Summary:

• Provides crisis intervention to individuals and families facing emergencies primarily around food and shelter.
• Conducts thorough needs assessment and develops a service plan to address identified concrete needs using a short-term intervention model.
• Conducts psycho social assessments of individual and family problems 
• Follow up with referrals to Catholic Charities programs or outside facility as deemed appropriate.
• Follows programmatic rules and guidelines set by contract or funding sources.
• Maintains current and accurate documentation of services provided to clients.
• Attends regular sessions with immediate supervisor.
• Assist with identifying and making arrangements for discharge planning needs, including potential alternative settings other than acute admission for patients in the emergency department.
• Supports Medical
• Staff QA through report generation, data submission, and analysis of data.

Skills on Resume:

• Crisis Intervention (Hard Skills)
• Needs Assessment (Hard Skills)
• Psycho-social Assessment (Hard Skills)
• Referral Management (Hard Skills)
• Program Compliance (Hard Skills)
• Documentation Accuracy (Hard Skills)
• Discharge Planning (Hard Skills)
• Data Analysis (Hard Skills)

Job Summary:

• Moderate dialogue and translation between data domain teams and use case squads during data domain roll out 
• Support use case squads in collaboration with data domain teams to identify and clearly specify challenges that could be resolved during roll-out to create value for the company
• Share best practices from previously supported use cases with data domain teams and use case squads
• Identify synergies around previously implemented use cases 
• Resolving difficult customer situations and handle escalated customer contact
• Representing the Client in contact with third parties and customer representatives
• Identifying fraudulent accounts and refer these to the Team Manager
• Initiating and putting forward suggestions to improve processes and procedures
• Ensuring individual performance targets and agreed objectives are achieved and maintained
• Working with other teams within the Debt Prevention Department

Skills on Resume:

• Dialogue Moderation (Soft Skills)
• Collaborative Support (Soft Skills)
• Best Practice Sharing (Soft Skills)
• Synergy Identification (Soft Skills)
• Conflict Resolution (Soft Skills)
• Client Representation (Soft Skills)
• Fraud Detection (Hard Skills)
• Process Improvement (Soft Skills)