Job Description
- Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
- Assist in the mentoring and training of new staff.
- Assume full responsibility for self-development and career progression.
- proactively seek and participate in ongoing trainings (formal and informal).
- Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
- Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
- Educates providers on how to submit claims and when/where to submit a treatment plan.
- Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
- Informs providers and members on Magellan?s appeal process.
- Lead or participate in activities as requested that help improve Care Center performance, excellence and culture.
- Links or makes routine referrals and triage decisions not requiring clinical judgment.
- Performs necessary follow-up tasks to ensure member or provider?s needs are completely met.
- Provides information regarding Magellan?s in-network and out-of-network reimbursement rates and states multiple networks to providers.
- Refers callers requesting provider information to Provider Services regarding Magellan?s professional provider selection criteria and application process.
- Refers patients/EAP clients to the Magellan?s Care Management team for a provider, EAP affiliate, or Facility.
- Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
- Support team members and participate in team activities to help build a high-performance team.
Company Profile:
Salary: Not disclosed
Industry: Medical / Healthcare / Hospital
Functional Area: Marketing
Role Category: Others
Employment Type: Full time
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