KEPRO (The Keystone Peer Review Organization), Inc. Looking for Lead Clinical Care Coordinator (Remote within Florida) at Tampa, Florida Full Time

Lead Clinical Care Coordinator (Remote)

• Are you an experienced Clinical Care Coordinator looking for a new challenge?
• Do you value care management and quality improvement?
• Are you motivated, energetic, and excited to become part of the CNSI/ Kepro team?

If so, you might be our next new team member!

This position will also cover: Orlando, West Palm Beach, Jacksonville, Miami

Who we need:

The Lead Clinical Care Coordinator provides care coordination outreach activities to support care management program. This position will act as a patient advocate by providing Immediate Advocacy between the patient and providers to ensure that the patient has what is needed. Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision-making skills to determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards.

Why us?

CNSI/ Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At CNSI/ Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package at CNSI/ Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What you’ll do:

• Ensures the responsible delivery of comprehensive services to enrollees.
• Conducts general assessments for supervisor/lead interpretation/evaluation and assignment to case manager / health coach based on results.
• Plans and participates in the interdisciplinary team meetings for collaborative assessment and coordination planning to ensure quality care.
• Proactively engages in delivery of quality management program activities that are the direct responsibility of the Health Services team. Assists in the achievement and ongoing maintenance of accreditations for defined programs.
• Provides education and resources to beneficiaries/families/providers.
• Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for services.
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
• Abstracts review related data/information accurately and timely on appropriate review tool by the appropriate means. Accurate and timely submission of all administrative and review related documents to appropriate parties.
• Performs ongoing reassessment of review process to offer opportunities for improvement and/or change.
• Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.
• Assists Supervisor in ensuring achievement of contractual obligations, including service delivery in a cost effective and efficient manner and through support of budgetary adherence by reporting accurate and timely work hours and expenses incurred during course of position duties.
• Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
• Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.
• Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following CNSI/ KEPRO policies, procedures and guidelines.
• Actively cross-trains to perform duties of other contracts within the CNSI/ KEPRO network to provide a flexible workforce to meet client/consumer needs.
• Other duties as assigned

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

What you’ll need:

Required Qualifications

• Active unrestricted RN, Social Worker or other applicable State and/or Compact State clinical license per contract requirements.
• Graduation from an accredited Diploma, Associates, Bachelor’s or Master’s Degree Program

Knowledge, Skills, Abilities

• Knowledge of current URAC standards strongly preferred
• Knowledge and familiarity with public sector health coverage systems, e.g. Medicare/Medicaid.
• Knowledge of principles, ethics and precepts of care management service delivery.
• Knowledge of customer service principles.
• Strong telephonic interviewing skills.
• Strong prioritization and organizational skills.
• Ability to receive verbal and written feedback in a professional manner and implement performance and productivity improvements as needed.
• Medical record abstracting skills required.
• Knowledge of the organization of medical records, medical terminology, and disease process required.
• Strong clinical assessment and critical thinking skills required.
• Excellent verbal and written communication skills required.
• Ability to work in a team environment.
• Flexibility needed.
• Strong computer skills, e.g. care management applications, Internet/Web, Microsoft Office (Word, Excel).

Experience

• RN – Minimum two years of pediatric experience required.
• LCSW, MSW- Minimum 1 year in related field

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in CNSI/ Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The CNSI/ Kepro Talent Acquisition Team