Job ID: J119838
Company: Highmark Inc
Location: Home, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: May 21, 2018
This incumbent is directly responsible to provide office based, hands-on assistance services (i.e. chart reviews, mass claims adjustments, UDC processes, etc.) to PCPs enrolled in Medicare STARS, Medicaid HEDIS and risk revenue programs and clinical evidence based guidelines. The Care Manager is expected to assess the needs of each individual PCP practice, and use a combination of on-site individual office based, entity level based, video conference, teleconference and electronic mail interactions to drive engagement and exemplary value creation, impact and cost control, and ROI/fiscal outcomes as set by the Organization for Pay for Value Programs.
*This is a work from home position for the Pittsburgh, PA, market requiring travel to provider practice facilities in a designated territory. Travel is required >75% of the time.
Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.
Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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