Title

Post-Acute Patient Access Specialist - Pre-Cert 

EOE StatementWe are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
 
About the Organization ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 45,000 employees, 11 hospitals, 2,100+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and senior care services.

ProMedica`s senior care division operates 330+ assisted living facilities, skilled nursing centers, memory care communities and hospice, palliative and home health care agencies. Services are provided in 26 states and the majority now operate under the ProMedica brand and Arden Courts. Over the next few months, the rest of our entities under the Heartland and ManorCare names will rebrand to ProMedica.

Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address and lead in social determinants of health, champion healthy aging and cultivate innovative solutions. For more information about ProMedica senior care services, please visit www.promedicaseniorcare.org.  
Specific Job Detail None Specified 

Sign-on Bonus None Specified 

Description

ProMedica Senior Care provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy.

Job Summary

The Post-Acute Patient Access Specialist - Pre-Cert role is responsible for managing/obtaining Managed Care authorization from key hospitals and other care settings (sites to be determined as part of the division market strategy) and ensuring a smooth transition of care for patients discharging from a care setting to our centers. Additionally, the Post-Acute Patient Access Specialist – Precert will develop a strong relationship with the key Managed Care or Third Party Administrator personnel and identify new opportunities for partnering and growth.

Responsibilities:

  • Processes inquiries received via referral management system, at a minimum rate of 5-15 inquiries per day, with an average response time rate of 15 minutes or less from the time the precert specialist assigned.
  • Manages referrals in conjunction with the MCO/TPA to ensure approval for admissions are received timely.
  • Makes IMPACT business calls to Managed Care Organizations to better understand their work flow to secure authorization timely, gain in-sight into their expectation of SNF criteria, and to understand program and service needs; in order to effectively communicates those needs with ProMedica Senior Care leadership.
  • Develops relationships by completing integration calls to precert personnel, utilization review personnel, MCO/TPA supervisors, and other professionals and related contacts at the MCO/TPA leading to an efficient and consistent process processing authorizations.

This PRN opportunity allows for remote work. Addtionally, we will be looking for an individual open to flexible weekday/normal buiness hours. 

In return for your expertise, you'll enjoy excellent training and unlimited opportunities to learn and grow. Be a part of the team leading the nation in healthcare.

 
Educational Requirements Bachelor degree preferred; Sales and medical training, required.  
Position Requirements

Two years of experience with sales and marketing knowledge, required; Strong medical assessment skills; Prior experience with an insurance company, private case management company, or HMO, preferred. Familiarity with long term care and/or subacute care, useful. Strong oral and written communications skills.

 
Location 693 - ProMedica Skilled Nursing and Rehabilitation - Moorestown, New Jersey  

This position is currently not accepting applications.

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