Care Advocate

City / State

Doral, FL

Overview

Work Shift

First (Days) (United States of America)

AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Care Advocate in Miami or Gainesville Florida.

This is a hybrid position, 2 days in office and 3 days remote.

Scope of the Position : The Care Advocate oversees the daily operations of the Case Management department by developing and using workflows and procedures that ensure the highest quality service and performance levels network coordination, authorization facilitation, claims resolution and administration.

Essential Job Functions :

• Manages referrals received by the case management department, including but not limited to eligibility verification, Coordination of Benefits issues, Center of Excellence inclusion and building care enrollment in the medical platform.
• Initiates and manages care enrollments in the medical platform.
• Runs all program reports, including timely receipt and disbursement to case management associates.
• Manages post-referral program completion, reconciles visit summaries to visit dates and ensures timely receipt; maintains a visit summary repository.
• Summarizes program results for case management leadership, including readmissions, referral volume, and open vs closed cases. 1
• Serves as liaison between members, physician groups and case managers.
• Performs additional duties and responsibilities as assigned by management.

Minimum Requirements :

• HS Diploma / GED
• 2 years of administrative experience in a clinical setting
• Bilingual in English / Spanish
• Knowledge of medical terminology
• Knowledge of Medicare benefits
• Familiar with Florida regulatory compliance standards
• Ability to meet deadlines in a consistent manner; able to manage multiple deadlines
• Knowledge of Utilization Management, Care Coordination processes
• Strong organizational skills; able to multitask and prioritize.
• Strong written / documentation and verbal skills-detail oriented
• Detail oriented

Preferred Qualifications :

• Experience in a call center environment preferred
• Microsoft Office
• Creating word documents, communicating with team via Outlook, creating and updates Excel spreadsheets
• Decision-Making
• Communications and Collaboration
• Organizational Skills
• Requires strong organization and prioritization

Our Benefits :

As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers.

We offer a variety of amenities to our employees, including, but not limited to :

• Medical, Dental, and Vision Insurance
• Paid Annual Leave, Sick Leave
• Flexible Spending Accounts
• Retirement funds with matching contribution
• Supplemental insurance policies, including legal, Life Insurance and AD&D among others
• Work Perks program including discounted movie and theme park tickets among other great deals
• Opportunities for further advancement within our organization

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace.

For information about our employee benefits, please visit : Benefits - Sentara (sentaracareers.com)

Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!

Note : Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind.

Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave.

Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

Keywords : Talroo-health Plan, #Indeed, Bilingual / Spanish, Medical Terminology, Medicare Benefits,

Job Summary

Care Coordination Technician works in a collaborative role with all members of the professional health care team and with community service agencies to coordinate care for members to improve health outcomes.

The Care Coordinator Technician has responsibility for providing direct support to Care Coordination staff and members by providing telephone triage for all incoming phone calls, data entry services for clinical, non-clinical information, distributing reports to staff for follow up, extracting data for on-going and ad hoc reports and other duties as assigned by LTSS leadership.

Makes routine / scheduled and ad hoc / follow-up calls to members in compliance with contractual requirements and the member's plan of care.

Assists Care Coordinators in arranging services associated with member's plan of care.

• 2 years of administrative experience in a clinical setting
• Knowledge of medical terminology
• Knowledge of Medicaid and Medicare benefits
• Familiar with Virginia regulatory compliance standards
• Ability to meet deadlines in a consistent manner; able to manage multiple deadlines
• Knowledge of Utilization Management, Care Coordination processes
• Strong organizational skills; able to multitask and prioritize.
• Strong written / documentation and verbal skills-detail oriented
• Detail oriented
• Experience in a call center environment preferred

Qualifications :

HS - High School Grad or Equivalent (Required)

Clinical, Managed Care, Medical Terminology

Skills

Microsoft Excel, Microsoft Office, Microsoft Word

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.

gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.