Remote Rn Abstractor Jobs in Grosse Pointe, MI (NOW HIRING)

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We're looking for the next generation of health care leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

The Supervisor, Medicare LTSS Operations is responsible for ensuring and improving the performance, productivity and efficiency of Medicare LTSS Care Coordination Operations. Under the supervision of the Manager LTSS, the Supervisor, Medicare LTSS Operations is responsible to provide operational oversite and process improvement supporting Medicare LTSS Operations including clinical direction and monitoring of Medicare LTSS case management services.

• Ensures effective daily operation of the Medicare LTSS Care Coordination team complying with all applicable statutory provisions, contracts and established policies and administrative procedures. 
  • Supervise staff, delegate tasks and accountabilities. 
  • Maintains optimal staffing patterns based on current departmental budget. 
  • Complies with all Human Resources Policies and Procedures for personnel requisitions, interviewing and being knowledgeable in and compliant with all plan policies and procedures relating to employee performance review, attendance, counseling and corrective action. 
  • Participates in and coordinates training and education of new and existing staff. 
  • Develop and maintain policies and procedures, workflows and desk level procedures as needed. 
• Actively pursue strategic and operational objectives relative to performance optimization. 
  • Assist in development of strategic plans for operational activity. Proactively works with stakeholders to develop business strategy, expansion of solutions and facilitate business renewal. 
  • Improve processes and policies in support of organizational goals.
  • Partner with cross-functional support teams to implement process improvement.
  • Identifies opportunities for program performance improvement and contribute to the development of initiatives related to compliance, performance and program expansion.
• Grow the efficiency of the existing organizational processes and procedures to support the quality and compliance of operations for Medicare LTSS Care Coordination, including regulatory performance. 
  • Ensures that operation objectives are created, on track and submits interim reports as requested by stakeholders. 
  • Works collaboratively with Medicare Quality Assurance, Medicare IS and Medical Informatics Departments, with a dotted line relationship to Medicare Chief Medical Officer. 
• Maintains a current knowledge of CMS and DHHS requirements.
• Adheres to AmeriHealth Caritas policies and procedures.
  • Creates and supports an environment with fosters teamwork, cooperation, respect and diversity.
  • Instills work culture of continuous process improvement, innovation and quality.
  • Demonstrates and supports commitment to corporate goals and objectives. 
• Performs other related duties and projects as assigned.
   

Work Arrangement:

• Qualified candidates must live in or around Wayne and Macomb Counties in Michigan. 

• Some field work required.

Education/Experience:

• Licensed Clinical Social Worker (LCSW) , Licensed Master Social Worker (LMSW), or Registered Nurse (RN).
• 1 to 3 years Supervision of remote team experience.
• 3 to 5 years LTSS Case Management experience.
• Proficient PC skills with Microsoft Office Suite (Word, Excel, etc.).
• Strong knowledge of Medicare/MMP/HIDE LTSS.
• Excellent problem solving and organization skills.

• Ability to work independently or as a team.

• Strong interpersonal communication skills.
• Ability to maintain positive relationship with both internal and external customers.
• Process Oriented.
• Attention to detail.
• Effective time management.
• Pro-active with ability to multi-task.
• The ability to consistently identify mistakes.
• The ability to closely follow quality standards.

• Decision making skills.

• Demonstrated experience developing and maintaining documentation, including participation in policy and procedure creation.

  
   

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.