Field Care Manager RN Humana IncField Care Manager RNBaton Rouge, LARemote$71,100–$97,800 / yearTo ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required. Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH's Medicaid Division cannot be considered for this opportunity.
Remote Triage RN CORE LLCRemote Triage RNBaton Rouge, LARemotePrincipal Duties and Responsibilities (Essential Functions): • Triage injury/illness calls to determine if emergent/non-emergent • Determine if injury/illness requires immediate treatment or first aid advice • Research/locate the nearest facility to utilize for injury • Contact medical facility to determine the availability of adequate services to meet the needs of the particular injury/illness; Coordination of visit via phone/fax. To learn more about this exciting opportunity, review the job specifications below: Position Overview: Under the direction of the Director of Injury Management, the Triage Nurse administers the intake of calls from contracted clients, an injured worker, Worker's Compensation Insurance adjusters, Medical providers, and clinic staff.
Remote Triage RN CORE Occupational MedicineRemote Triage RNBaton Rouge, LARemotePrincipal Duties and Responsibilities (Essential Functions): • Triage injury/illness calls to determine if emergent/non-emergent • Determine if injury/illness requires immediate treatment or first aid advice • Research/locate the nearest facility to utilize for injury • Contact medical facility to determine the availability of adequate services to meet the needs of the particular injury/illness • Coordination of visit via phone/fax • Speak with Medical personnel regarding the mechanism of injury/illness and discuss appropriate treatment pathways, obtaining UDS and BAT when applicable, and workplace accommodation availability • Inform client/injured worker of name/location and contact information of medical facility available • Notify appropriate contacts via email of injury/illness details with initial information within one hour of notification, unless an extreme situation • Provide updates of diagnosis, work status, plan of care and follow up appointments to appropriate personnel with injured workers employer and adjuster • Provide updates, diagnosis, clinic notes and treatment authorization requests to designated representative for client and Workers Compensation insurance adjuster • Log injury/illness details on spreadsheet • Client specific Bill time for each case according to services rendered • Generating letters to providers, for clarification of work-relatedness and or treatment plan • Obtaining and reviewing Medical records and diagnostics with relation to present injury/illness, prior history and/or forwarding to Specialty providers when allocated • Proper documentation of phone calls made and received, interpretation of medical records from each exam, work status, and all emails transpired with regard to each case • Assist Upper Management in CM activities as requested • Answer phones in a professional manner when receptionist is not available • Attend and participate in staff meetings • Assists in office related tasks as needed • Participate in opportunities for learning and skill maintenance/development, including internal and external training and workshops. To learn more about this exciting opportunity, review the job specifications below: Position Overview: Under the direction of the Director of Injury Management, the Triage Nurse administers the intake of calls from contracted clients, an injured worker, Workers Compensation Insurance adjusters, Medical providers, and clinic staff.
Program Integrity Clinical Specialist (RN or PA Req'd) TriWest Healthcare AllianceProgram Integrity Clinical Specialist (RN or PA Req'd)Baton Rouge, LARemoteFull timeTechnical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews.
Director, Medical Document Optimization TriWest Healthcare AllianceDirector, Medical Document OptimizationBaton Rouge, LARemoteFull timeLeadership: Ability to set strategic direction and translate organizational goals into operational plans; successfully leads and develops staff across varying styles and levels; provides clear expectations, effective coaching, and timely feedback; leads through a subordinate manager and drives accountability at all levels of the department. Problem Solving / Analysis: Ability to solve complex operational and systems-related problems through systematic analysis of data, workflows, and processes; exercises sound judgment in ambiguous or high-stakes situations; identifies root causes and implements durable solutions with a realistic understanding of organizational constraints.
Remote Case Manager (RN) CORE LLCRemote Case Manager (RN)Baton Rouge, LARemotePrincipal Duties and Responsibilities (Essential Functions): • Triage injury/illness calls to determine if emergent/non-emergent • Determine if injury/illness requires immediate treatment or first aid advice • Research/locate the nearest facility to utilize for injury • Contact medical facility to determine the availability of adequate services to meet the needs of the particular injury/illness; Coordination of visit via phone/fax. To learn more about this exciting opportunity, review the job specifications below: Position Overview: Under the direction of the Director of Injury Management, the Case Manager administers the intake of calls from contracted clients, an injured worker, Worker's Compensation Insurance adjusters, Medical providers, and clinic staff.
Remote Case Manager RN CORE Occupational MedicineRemote Case Manager RNBaton Rouge, LARemotePrincipal Duties and Responsibilities (Essential Functions): • Triage injury/illness calls to determine if emergent/non-emergent • Determine if injury/illness requires immediate treatment or first aid advice • Research/locate the nearest facility to utilize for injury • Contact medical facility to determine the availability of adequate services to meet the needs of the particular injury/illness • Coordination of visit via phone/fax • Speak with Medical personnel regarding the mechanism of injury/illness and discuss appropriate treatment pathways, obtaining UDS and BAT when applicable, and workplace accommodation availability • Inform client/injured worker of name/location and contact information of medical facility available • Notify appropriate contacts via email of injury/illness details with initial information within one hour of notification, unless an extreme situation • Provide updates of diagnosis, work status, plan of care and follow up appointments to appropriate personnel with injured worker's employer and adjuster • Provide updates, diagnosis, clinic notes and treatment authorization requests to designated representative for client and Worker's Compensation insurance adjuster • Log injury/illness details on spreadsheet; Client specific • Enter injured worker, adjuster name and claim number into Billing Portal to apply billing time and status of case as it occurs • Bill time for each case according to services rendered • Field Case Management services for client/injured worker needing onsite Case Management services at the time of visit. This includes communicating directly with the provider and obtaining pertinent paperwork at the visit • Generating letters to providers, for clarification of work-relatedness and or treatment plan • Obtaining and reviewing Medical records and diagnostics with relation to present injury/illness, prior history and/or forwarding to Specialty providers when allocated • Proper documentation of phone calls made and received, interpretation of medical records from each exam, work status, and all emails transpired with regard to each case • Coordinate SMO's with specialists as needed • Coordinate FCE's to determine job capabilities • Rotate Call to ensure 24/7/365 CM services; perform duties as stated above for calls received • Transfer phone lines every morning and evening for phone coverage 24 hrs a day • Assist Upper Management in CM activities as requested • Answer phones in a professional manner when receptionist is not available • Attend and participate in staff meetings • Assists in office related tasks as needed • Participate in opportunities for learning and skill maintenance/development, including internal and external training and workshops.
Chief of Staff to the Chief Operating Officer TriWest Healthcare AllianceChief of Staff to the Chief Operating OfficerBaton Rouge, LARemoteFull timeTechnical Skills: Proficient in current trends in health care management with emphasis in customer service, network management, utilization and financial trends; collaboration skills to work with TriWest management team across multiple locations; networking skills with all levels, including subcontractors. • Works on multiple high level projects including logistical coordination, data analysis, contract management and written communications in support of various business initiatives of high visibility, applying project management tools and methodologies and leadership skills to meet or exceed deadlines.