Managed care coordinator job description

Wound Care Coordinator(2232789) Description The Wound Care Coordinator directs, organizes, and develops all wound care services in accordance with applicable federal, state, regulatory, and company standards to ensure the delivery of quality patient care is rendered at all times, and that the Plan of Care and physician orders are followed with regard to wound care treatments. This position functions independently, demonstrates above average communication skills, personal integrity, and works effectively with patients, family members, physicians, staff, and outside agencies as required. The position leads hospital wound education efforts, as well as educates patients and family members on wounds and wound care topics. While this position does not specifically supervise clinical staff, as the leader of the wound care program in the hospital this person does direct clinical team on wound care treatment. This position requires continuous updating of education and treatment techniques in the delivery of wound care.Job Code: 100139Qualifications License or Certification:
- RN, Physical Therapist, or Occupational Therapist required for acute rehab hospitals
- RN required for long term acute care hospitals
- Wound Care Certification
- CPR certification required
Education, Training and Years of Experience:
- Continuous updating of wound care knowledge through seminars and professional organizations is required
- Minimum One Year experience in wound care
Machines, Equipment Used:
- General office equipment such as telephone, copy machine, fax machine, calculator, computer.
Physical Requirements:
- Good visual acuity and ability to communicate.
- Ability to lift, lower, push, pull, and retrieve objects weighing a minimum of 30 pounds, which includes participating in patient mobility activities.
Compliance:
- Adheres to the company's Standards of Business Conduct.
- Maintains current licensure and/or certifications, if applicable.
Skills and Abilities:
- Ability to speak, read, write, and communicate effectively.
- Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner.
- Ability to work independently without supervision.
Environmental Conditions:
- Indoor, temperature controlled, smoke-free environment. Occasional outdoor exposure.
- Exposure or potential exposure to blood and body fluids may be required.
- Handicapped accessible.
- May work under stressful circumstances at times.
Proficiency or Productivity Standards:
- Meets established attendance standards.
- Adheres to hospital/department dress code including wearing ID badge.
- May be required to work weekdays and/or weekends, evenings and or night shifts if needed to meet deadlines.
- May be required to work on religious and/or legal holidays on scheduled days/shifts.
- Will be required to work as necessary during disaster situations, i.e., before, during or after a disaster.
- May be required to stay after workday to assist after a disaster situation until relief arrives.
- May be required to perform other duties as assigned by supervisor.
Primary Location: Arizona-Scottsdale-ScottsdaleJob: NursingEmployee Status: Regular

Who we are looking for:

Are you the Intensive Care Coordinator we have been looking for? In this position you will be able to convey your passion for helping others by supporting our clients to achieve their goals! JRI's Community Service Agencies are dedicated to providing high-fidelity wraparound services for youth under the age of 21 who have been diagnosed with a serious emotional disturbance who require multiple services or are involved with multiple child-serving systems such as child welfare, special education, or juvenile justice. Our staff work collaboratively with the youth's team to provide an individualized care plan and are committed to keeping youth safely in the community with the assistance of their natural supports.

JRI provides the training so that:

YOU will be able to facilitate Care Planning Teams; coordinate multiple services/supports for MassHealth-enrolled children and youth under the age of 21 with serious emotional/behavioral health needs.
YOU will act as a liaison with individuals, partnering agencies, and supportive programs or services to guide the care of youth.
YOU will identify, assist families in accessing, and monitor available services and natural supports for youth and families.
YOU will provide culturally competent, trauma informed, wrap-around services that center the needs of the youth.
YOU will support parents and caregivers in learning effective advocacy skills.

Bilingual a plus!! We offer a $1000 bilingual bonus to any candidate who speaks, reads and writes in a different language other than English.

Why JRI?

Be who you are! JRI is strongly committed to providing an inclusive, diverse and welcoming environment for our employees and the people we serve.
Access to our excellent Blue Cross medical and Delta Dental benefits.
Retirement benefits including 401K matched up to $800 a year and pension after 5 years of employment.
Professional development opportunities such as tuition reimbursement up to almost $4000 per year and discounted tuition rates to select partnership colleges and universities!
Wellness benefits including access to employee resource groups (including multicultural affinity groups, LGBTQ+ advocacy, employee engagement groups, etc.), self-care resources, and an Employee Assistance Program.
Generous paid time off up to 19 days for full time employees in your first year and much more!

Requirements:

Bachelor's or Master's Degree in Social Work or other related field required.
Must have daily access to reliable, insured vehicle and active Driver's License.
Must be willing to maintain a flexible work schedule evening and some weekend hours.
Experience navigating child/family-serving systems and working collaboratively with state agencies, consumer advocacy groups, and/or behavioral health facilities is preferred.
Experience in working with and advocating for children/families with serious emotional/behavioral health needs is preferred.
Knowledge of Wraparound systems of care and child welfare is preferred.
Background and driving record checks will be performed.

JRI is strongly committed to providing an inclusive, diverse and welcoming environment for our employees and the people we serve. Persons from diverse backgrounds including women, communities of color, the LGBTQ community and people with disabilities are encouraged to apply. JRI is an equal opportunity employer.

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Role Value Proposition:


Global Operations focuses on creating positive experiences for MetLife customers and helping the company make the best use of its global resources. We're looking for unique talent with fresh perspectives that can propel innovation. In this role you will evaluate long-term care claims and exercises independent judgment, discretion and critical analysis to reach reasonable claims determinations that are in accordance with contract provisions and time service standards.


Key Responsibilities
:

Manages assigned caseload with limited supervision. Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast paced environment. Compiles file documentation requiring extensive policy and factual detail. Identifies information and resources needed to make benefit eligibility determinations. Communicates decisions to policyholders and or their representatives in both verbal and written form. Clarifies and reconciles inconsistencies. Conducts in depth detailed information-gathering phone calls that obtain medical condition details and other information.



Essential Business Experience and Technical Skills:


Required


Strong communication skills, both written and oral Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning Experience using MS office products Strong organizational skills. High School Diploma/GED



Preferred


Bachelor's Degree 2-4 years of Long-Term Care Experience



Business Category


LTC


Number of Openings


6


At MetLife, we're leading the global transformation of an industry we've long defined. United in purpose, diverse in perspective, we're dedicated to making a difference in the lives of our customers.”



MetLife:


MetLife, through its subsidiaries and affiliates, is one of the world's leading financial services companies, providing insurance, annuities, employee benefits and asset management to help its individual and institutional customers navigate their changing world. Founded in 1868, MetLife has operations in more than 40 countries and holds leading market positions in the United States, Japan, Latin America, Asia, Europe and the Middle East.

We are one of the largest institutional investors in the U.S. with $642.4 billion of total assets under management as of March 31, 2021. We are ranked #46 on the Fortune 500 list for 2021. In 2020, we were named to the Dow Jones Sustainability Index (DJSI) for the fifth year in a row. DJSI is a global index to track the leading sustainability-driven companies. We are proud to have been named to Fortune magazine's 2021 list of the “World's Most Admired Companies.”

MetLife is committed to building a purpose-driven and inclusive culture that energizes our people. Our employees work every day to help build a more confident future for people around the world.

We want to make it simple for all interested and qualified candidates to apply for employment opportunities with MetLife. For further information about how to request a reasonable accommodation, please click on the Disability Accommodations link below.

MetLife is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at MetLife without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.

MetLife maintains a drug-free workplace.

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