Nurse Case Manager-Telecommuting

Department:  AmeriBen Compass Medical Mgmt
Supervisor: Compass Supervisor
Shift:  Exempt
Pay Range: $47,756-$58,491

A Nurse Case Manager will, in accordance with the Nursing Process, the Standards of Nursing Practice, and URAC regulations, facilitate the appropriate health care services in the most cost effective manner to promote an optimal outcome without compromising quality of care.  An additional benefit to this position is the ability to telecommute after the 90 day introductory period if eligibility requirements have been met. 

Key Result Areas:  

  • Establish personal contact with patients and family members
  • Assess the patient's current status, prognosis, future care needs, treatment plan and alternative treatment plans
  • Assess the family dynamics and home environment and needs
  • Identify barriers to recovery
  • Adhere to all URAC standards
  • Develop and implement individualized Case Management plans
  • Evaluate effectiveness of care plan and progress made by patient
  • Document findings and appropriate cost effective recommendations within identified timelines using URAC regulations
  • Capture and record any  cost savings
  • Act as a liaison between referral source, family, employee, physician, facilities and providers, employer and internal and external stop loss
  • Maintain confidentiality of records and information
  • Maintain and report applicable statistics regarding programs and patient services  

Minimum Qualifications:  

  • Current Idaho R. N. license and CCM certification or 2 years Case Management experience and eligible to sit for the CCM certification exam
  • Diverse clinical experience
  • Knowledge of HIPAA and DOL regulations
  • Strong interpersonal relationship skills and the ability to work effectively with a diverse patient population.
  • Ability to communicate effectively, both orally and in writing, medical information to health care professionals, employer groups, Brokers, stop loss personnel, internal customers, members and patient families
  • Ability to work independently
  • Time management, Organizational, Research, Analytical, and Records Maintenance skills
  • Negotiation skills
  • Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines \
  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self
      

Customer Care Representative I

Department: Customer Care Services                           
Supervisor: Cust. Care Sr, Lead
Shift:  Monday - Friday, 7am-6pm
Shift: 8 Hour May Vary                               
Posting Expires: 3/9/10
Pay Range: $11.45 - $13.45                                          
 
 
As a Customer Care Representative, you answer or direct incoming calls and respond to customer inquiries regarding claims benefits which will involve researching and resolving problems for customers. 

Key Result Areas:

  • Answers incoming telephone calls
  • Responds to claims questions from customers regarding benefits, eligibility and coverage. Explains policies to customers
  • Researches customer inquiries, completes the follow-up and paper work
  • Research calls returned within 48 hour turnaround time or as promised
  • Must meet 5 day turnaround time with Call Tracking
  • Must take an average of 60 calls per day after training has been completed

Minimum Qualifications:

  • High school education or equivalent
  • Minimum one year of customer service experience
  • Knowledge of medical and dental terminology a plus
  • Excellent customer service attitude and professionalism
  • Team and goal oriented
  • Exceptional interpersonal and problem solving skills
  • Good organizational, written and verbal communication skills
  • Types 45 wpm, 10-key and computer knowledge
  • Good knowledge of Microsoft Office software (Word, Excel, Power Point, and Outlook)
  • Ability to organize, work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines
  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self
     

Client Accountant I

Department:  Client Accounting
Supervisor:  Client Accounting Supervisor
Shift:  Hourly
Posting Expires:  3/9/10
Pay Range:  $12.82-$15.07

This position is responsible for various accounting functions such as Invoicing, resolving vendor A/P and A/R issues, CT check research and resolve, split checks writing, posting journal entries in CFUND, processing Corporate deposits and Bank reconciliations.  Additional responsibilities include processing and calculating monthly special revenue and invoice Clients as well as handling the special accounts for Cache Creek and Lytton, Unclaimed Property and acts as the Lead on the monthly Credit Intec review.

Key Result Areas

Essential

  • Handles the Special Revenues accounting by calculating fees, generating monthly invoices, and maintain records and fees for reporting as required. 
  • Accurately records manual checks in CFUND for Client expenses.
  • Processes and deposits Corporate checks a timely manner.
  • Responsible for the bi-monthly Credit Intec auditing and tracking and accounting for NCR & PSR.
  • Processes daily Call Tracking inquires about checks status and other issues, by researching and accurately reporting data. 
  • Responsible for research, adjustments and reporting of Client's Unclaimed Property.
  • Collects, reviews, validates misc invoices, preparing them for final approval for payment by Supervisor.
  • Generates Schedule C's for Client's IRS 5500 reporting.
  • Reports administration fees for PG groups on a quarterly basis.
  • Handles the special accounting needs for Cache Creek and Lytton Tribe.

Additional

  • Completing special projects as assigned.
  • Provide back up to clerical functions as necessary and support Supervisor as needed.

Minimum Qualifications

  • Prefer some college education in Accounting, Business or related fields, and having at least 2 years experience in accounting and/or banking related functions.
  • Possesses a solid understanding of accounting principles and business practices.
  • Strong research and problem solving skills, with focused attention to detail and accuracy.
  • Intermediate aptitude for computers and programs, and having a high aptitude and accuracy for data entry.
  • Ability to work efficiently on both structured and non-structured tasks, prioritizing work and managing workload to meet tight deadlines. 
  • Possesses solid integrity, initiative, teamwork and good judgment skills, as well as professional communication skills.
  • TPA or health insurance industry knowledge and experience preferred.
  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self.

Typical Minimum Standards

  • Efficiently work with clients and vendors on the phone to address and resolve accounting issues.
  • Show flexibility as a team player and ability to multi-task.
  • Adherence to the values and mission of AmeriBen.