Advanced Practicing Nurse / Physician Assistant
Company: Friday Health Plans
Location: Alamosa
Posted on: May 12, 2022
Job Description:
Who You Are
You are a compassionate communicator with strong analytical
talents. You have solid interpersonal skills and can make quick
judgment calls. You are a multi-tasker and detail oriented. Under
the general direction of the Medical Director, this role has
primary responsibility for development and daily management of
health care service activities related to the delivery of medical
care for Friday Health Plan members. The Advance Practicing Nurse /
Physician Assistant encompasses utilization management (including
case management and referrals), quality management and appeals
resolution.
Who We Are
Friday Health Plans isn't your average health insurance company.
We're not about unnecessary extras and confusing terminology. We
cover the basic health services you'll likely use the most at a
price that just might make your wallet happy. Our simple health
plans and friendly service keep you covered so you're free to live
every day like it's Friday.
As a Denver-based startup company, we're looking for smart,
talented people like you to join us. We value collaboration,
innovation, passion, and a calculated risk-taking. Now in year four
and growing rapidly, we're looking for people who lead by example,
and that example is one of flexibility, reliability, and
positivity. If this sounds like you, then we want you on our
team.
What You'll Do
- Has responsibility in assisting with the implementation of
policies and procedures for the Medical Department
- Oversee member Wellness Programs
- Assists as needed in the preparation of quarterly and annual
reports for the Medical Director and the Board of Directors,
including information about Quality Management (QM) and Utilization
Management (UM) activities and denials
- Ensure compliance with all relevant federal and state statues,
regulations, rules and guidelines that pertain to the medical
department
- Provides department metrics as needed to the Clinical Medical
Manager for submission to the Quality Management Program
Committee.
- Review and approve referrals and authorizations per established
guidelines; involve Medical Director when guidelines are not met or
not applicable and deny referrals from providers of similar
licensure.
- Perform concurrent review of hospital admissions and assist
with discharge planning on a daily basis. Keep Medical Director and
administration informed of census including high-risk and high-cost
cases
- Develop and maintain good working relationships with
information management and case management personnel at
participating hospitals, clinics and other health care
agencies
- Assist other agency discharge planners in obtaining and
coordinating services across the continuum of care (e.g., skilled
care, home care, or health education)
- Work with the Clinical Medical Manager to identify, develop and
implement projects related to utilization issues; has primary
responsibility for implementation of same
- Maintain current knowledge of UM and CM guidelines
- Assists as needed with the Medical Grievance and Appeals
process.
- Have a working knowledge of state and federal grievance and
appeals procedures as well as the policy and procedures of Friday
Health Plans
- Provide input into activities designed to improve HEDIS
scores
- Identify and implement case management plans specific to
individual needs for selected members in consultation with Medical
Director
- Follow established policies and procedures for UM, CM, and DM
(disease management) and assist the Clinical Medical Manager, as
needed, for modifications to same
- Assist with claims processing as requested by the claims
department
- Provide support as needed to the non-clinical members of the
department
- Maintains a working knowledge of all current plan
documents
- Ensures that all clinical denials are handed off to a medical
director
- Other duties as assigned
Required Knowledge, Skills & Abilities:
- Ability to balance multiple competing priorities
- Ability to function at a high level with minimum
supervision
- Excellent organizational skills
- Strong computer skills, including proficiency in word
processing and spreadsheet software, and ability to find and
utilize online resources
- Professionalism and the ability to use diplomacy in working
relationships
- Excellent oral and written communication skills
- Proven leadership ability, including creation and
implementation of new projects
- Good analytic skills
- Broad clinical knowledge base to assist in decision making
procedures
Required Education/Experience:
- Current Nurse Practitioner (APN) or Physician Assistance
licensure with a minimum of 2 years clinical experience is required
and 5 years is preferred
- Knowledge of computer and basic office equipment
How You'll Be Valued:
- Medical, Vision, and Dental premiums for you and your family
covered at 100%
- Company funded health savings account (HSA)
- 401(k) and 401(k) matching
- Company paid life insurance
- Company paid short- and long-term disability insurance
- Employee assistance program
- Paid time off and 10 paid holidays
- A company culture that is regularly recognized as a Top
Workplace by organizations such as CoBiz
- Salary $94,000 - $104,000
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Keywords: Friday Health Plans, Pueblo , Advanced Practicing Nurse / Physician Assistant, Healthcare , Alamosa, Colorado
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