Job Description

Location: Novato

Employment Status: Full-Time

General Summary
This position coordinates utilization review and case management activities for commercial and Medicare enrollees. The Utilization Review Nurse is knowledgeable about the Nurse Practice Act, NCQA, Millman Care Guides, and the Center for Medicare and Medicaid, HMO timeliness rules and pertinent state and federal regulations.

Principle Accountabilities

• Review routine referral/service requests on assigned patients in accordance with NCQA timeliness standards and health plan benefit structure.
• Prepares and presents cases for medical director review in a concise, objective and organized manner.
• Assists with identifying patterns and trends and develops and implements corrective actions when necessary.
• Educates and supports members in accessing care using their HMO and Medicare Advantage benefits as needed.
• Identifies and refers patients to disease management, wellness programs and community resources whenever relevant.
• Assesses members’ physical, psychological, social, environmental, financial and functional status as necessary and informs the patient’s treating physician of clinically relevant findings.
• Collaborates with the oncurrent review.

Job Requirements

Education:
• Current California RN License with no restrictions
• BSN Preferred

Experience:
• Minimum five years of clinical experience.
• Experience strongly preferred in one or more of the following: HMO, Health plan, Medicare, Utilization Management, Case Management

Knowledge, Skills, and Competencies
• Ability to understand and facilitate communication among team members, patients, families, physicians and medical office staff.
• Ability to communicate effectively with contracted health plans and meet required turn around times
• Good clinical judgment, critical thinking skills and independent problem resolution
• Ability to organize and prioritize workload
• Good working knowledge of Microsoft Office, Outlook, EHR, prior Health Care Management/authorization software.

Benefits

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Job Description

Location: Core PT-San Rafael

Employment Status: Per Diem

General Summary
This administrative physical therapy staff position is a combined position that incorporates both “front” office and “back” office (P.T. Aide) roles and responsibilities. Prior PT office experience is preferred but we are willing to train the right candidate.
• Greet patients, check them in for appointments, answer general questions, issue paperwork and assist with completion if indicated; notify physical therapists of each patient’s arrival.
• Answer phones, log all patient issues into electronic documentation system as they occur.
• Verify insurance eligibility and independently clarify questions/obtain answers from insurance plan representatives.
• Determine and collect correct co-payment amounts. Enter billing charges into system.
• Schedule new patient and follow up appointments.
• Enter authorization requests for continued physical therapy
Physical Therapy Aide Duties
• Help maintain lobby, and treatment areas.
• Change linens in rooms between patients as therapists don’t use sheets with every patient.
• Assist patients with set up and on/off gym equipment as directed by physical therapist.
• Perform ultrasound, light therapy treatments as directed by physical therapist.
• Set up/remove patients from other modalities. Set timers and check on patients as needed.
• Set up treatment rooms in preparation for specific patients.
• Act as a stand-by assist for physical therapist during client treatments as needed.
• Monitor treatment timers.
• Other duties as required.

Job Requirements

Qualifications
• Prior work experience as a Receptionist, Medical Office or similar role
• Working knowledge of medical office software/EHR. Proficiency in Microsoft Office Suite with accurate keyboarding skills
• Hands-on experience with office equipment (e.g. fax machines and printers)
• Professional attitude and appearance
• Solid written and verbal communication skills
• Ability to be resourceful and proactive when issues arise
• Excellent organizational skills
• Multitasking and time-management skills, with the ability to prioritize tasks
• Customer service attitude

Benefits

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