Understand the Culture and Values of Southwest Medical and OptumCare Learn about Population Management and the way it is implemented at Southwest Medical Get to know Southwest Medical Providers and Staff Mentoring by Southwest Medical Physicians Opportunity to do elective rotation with Southwest Medical Attend Quarterly provider meetings and monthly department meetings wh

Screens and identifies members with high risk, long term chronic conditions who will benefit from care management services. Monitors utilization as needed. Referrals for cases may originate from various sources Performs member evaluations and onsite visits as needed in multiple settings, including but not limited to telephonic, member's homes, PCP/Specialists clinic, hosp

Proficient in review of medical records and the ability to identify pertinent information on which to base appropriate clinical decisions. Document relevant chronology of case review and provide rational for determination Plan, prioritizes, organizes and completes work to meet established objectives. Excellent verbal and written communication skills with internal and exte

Greets patients as they arrive and manage appropriate standard wait times Complete check in and check out tasks to include insurance verification, complete pre authorizations and/or precertification of procedures, and copy required documents Collects co payments, co insurance, and deductibles and issues receipts Manages cashier box and daily deposits according to company

Obtain accurate and updated patient information, such as name, address, insurance information Perform insurance verification on the date of service Obtain patient signatures for required documents Upload a valid Government issued state ID of patient and patient insurance cards File and maintain medical records Consistently correct registration work queue errors Confirms a

Accurately and professionally handling all front desk operations including answering phones, greeting patients, collection of applicable co insurance and/or co payments and scheduling of diagnostic and follow up appointments, patient registration, insurance verification, balancing daily collections, addressing routine inquiries, and forwarding non routine requests to appr

Greets patients, family members and guests with a friendly smile Assists patients with signing in and completing registration Enters and scans patient's demographic and insurance information into Epic Verifies insurance eligibility and benefit information; informs patients of insurance benefits Collects co payments and patient balances Answers incoming phone calls in a co

Collaborate cross organizationally in the development, proposing and prioritization of customer solutions to reduce trend (programs, processes, benefit design, network, etc.) Works with business partners to ensure are aligned with successfully achieving savings targets Development and execution of cross functional strategies, projects and tactics which result in increment

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Utilize both company and community based resources to establish a safe and effective case management plan for members Collaborate with patient, family, and healthcare providers Identify and initiate referrals for social s

Greets patients as they arrive and manage appropriate standard wait times Complete check in and check out tasks to include insurance verification, complete pre authorizations and/or precertification of procedures, and copy required documents Collects co payments, co insurance, and deductibles and issues receipts Manages cashier box and daily deposits according to company

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer to peer discussions Be knowledgeable in

Answers multiple departmental phone calls; responding to customer requests including, and not limited to cross departmental appointment scheduling, screening and routing calls, takes messages and forward as appropriate Communicate with providers regarding scheduling preferences, and ability to respond to urgent patient needs in accordance with established departmental pro

Greets patients as they arrive and manages wait time Complete check in and check out tasks to include insurance verification, complete pre authorizations and/or precertification of procedures, and copy required documents Collects co payments, co insurance, and deductibles and issues receipts Manages cashier box and daily deposits according to company policies Processes wa

Assesses patient and family psychosocial needs and develops plan of care in concert with patient, physicians, nurses, HAs, other members of the departmental team and works in collaboration with other departments/programs such SCC/PAL, CAL AIM, ECM, MOC/SNP, CARE +, regional, SNFs, HIHR, Readmissions, Welcome Wagon, and Psych TOC Works in collaboration with CDOs Legacy App

Responds to incoming phone calls and desktop items and refers if necessary. Calls patients as directed and/or as necessary to follow up and/or schedule appointments Coordinating and preparation of reports, analyzing data and identifying solutions Developing, maintaining, Excel, Smartsheet, Tableau reports, and other systems as needed Completes administrative projects and