Clinical Claims Specialist

Its the new age of independence. And its changing the way we live.
BE PART OF IT. UNIVITA is dedicated to helping people live and age with independence. By providing a single place to find and manage resources which support independent living, UNIVITA makes it easier to access care and to age safely at home. This is your opportunity to join an innovative company with a culture that promotes compassion, trust and accountability. ABOUT THIS OPPORTUNITY This position serves as a primary Long Term Care Claims and Care Management clinical and technical resource. Partnering with Operations, Senior Management, Client Services, Business Development and client representatives. Also, provides back-up to VP Clinical Services.RESPONSIBILITIES1.Represents Clinical Services in case consultation with Operations and clients; includes shared responsibility for items submitted to the Medical Director mailbox from Operations staff.
2.Provides final review and sign-off on all recommendations to clients on reconsideration and appeal of adverse care management decisions.
3.In the absence of VP Clinical Services, represents Univita as Claims and Care Management technical expert as requested by Senior Management, Client Services and Business Development.
4.Provides final review and sign-off on behalf of Clinical Services on all proposed new and revised Clinical Practice Standards.
5.Acts as final arbiter on all Clinical Audit error rebuttals.
6.Provides primary sign-off, subject to final review by VP Clinical Services, on new and revised Care Management decision and plan of care tools, as well as clinical protocols.
7.Participates in regularly scheduled client meetings, including, but not limited to, weekly CalPERS Appeals meeting.
8.Represents Clinical Services in revisions to Requirements and Analysis Documents.
9.Represents Clinical Services in review of proposed changes to standard letters and in creation of new letters and forms.
10.Provides review, as requested, of free form letters by Clinical Services and Operations staff.
11.Provides Care Management training support as back-up to training done by auditing team.
12.Prepares training material, both text and PowerPoint, as back-up to material prepared by auditing team.
13.Other duties as assigned.
 Requirements
QUALIFICATIONS
Levels
Minimum QualificationsBachelor or Associates Degree
Five (5) or more years of experience in LTC Care Management and/or Geriatric Care.
Exceptional written and verbal communication skills.
Excellent analytical skills.
Certifications required: LSW or RN
Continuing education requirements: As required to maintain professional licensePreferred QualificationsAdditional certifications and qualifications:
Competency in Microsoft Word, PowerPoint, Excel
Experience as clinical trainer and/or mentorENVIRONMENT and COGNITIVE /PHYSICAL DEMANDS
Office environment
Ability to read, hear, speak, keyboard, and reason and problem solve.Requires prolonged sitting and telephone usage.
Requires the use of office equipment such as computer terminals, telephones or copiers.
Infrequent lifting up to 20 pounds.

Country: USA, State: Minnesota, City: Eden Prairie, Company: Univita.
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