Clinical Services Associate - Catastrophic Care Management at Paradigm Management Services, LLC in Lombard, IL

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Description

Description:

For almost 30 years, Paradigm has been the industry leader in solving complex health care challenges and improving lives. With the most connected and experienced team in health care, we define and deliver outcomes that exceed financial and health expectations for our clients, as well as for individuals and their families.


Paradigm delivers its solutions through three divisions: Catastrophic Care Management, Complex Care Solutions and Specialty Networks. The Paradigm divisions are built on expertise from five best-in-class businesses: Paradigm Outcomes, The ALARIS Group, Encore Unlimited, ForeSight Medical and Adva-Net. Founded in 1991, Paradigm is headquartered in Walnut Creek, California with offices across the U.S.


SUMMARY:

This position holds accountability for providing operational support and backup to the clinical operations team. Under the direction of the clinical operations team and the supervision of the Director, Operations, this may include tracking of customer deliverables, direct administrative support for the Clinical Services Coordinator team, maintenance of data to ensure accuracy and completeness in company-wide clinical databases and applications, facilitation of patient management team communication and general support of both the Network Manager and the Director of Clinical Services to ensure proactive, well-conceived and executed management plans.


ESSENTIAL RESPONSIBILITIES include the following. Other work-related duties may be assigned.

  • Support of development of contract budgets, including researching costs and ARCH budget entry and tracking of appropriate documents to support contract development. Participate and /or facilitate and document results of all patient related conferences as requested by the Director of Clinical Services.
  • Ensuring smooth administrative management of all assigned Paradigm cases, including tracking and routing of all injured worker related administrative forms.
  • Complete data entry, quality assurance review of data, and ongoing updating and maintenance of data in the patient database based on information received from the Director of Key Accounts (DKA), Clinical Services Coordinator (CSC), and/or Network Manager. Track and process all electronic communications submitted to the Case Related email boxes, complete assigned tasks in EDDG.
  • Tracking of all customer deliverables to ensure timely submission that meet company Standards of Performance. Initiate appropriate action plans for late reports or contracts.
  • Complete required procedural steps in the patient database, Tasking Application and/or EDDG for documents submitted to the customer and additional required actions upon customer acceptance of a contract and/or agreement to contract completion.
  • Utilize appropriate applications and databases to prepare or create various documents that support the document production/case management process including creating and updating Complexity Calculations; distributing periodic reports to the Network Managers.
  • Support timely development of Lifetime Medical Cost Estimates
  • Participate in the report review process as required by established workflow procedures.
  • Collaborate with other internal departments (Contracting, Claims, and Accounting) to address and resolve specific patient /provider issues.
  • Other administrative duties as requested, including uploading of records in ECL, documentation and archiving of patient notes, research regarding patient specific issues and tracking of deliverables as requested.
  • Participate in company projects requiring representation from the Clinical Services Coordinator team, as
  • requested by management.
  • Responsible for complying with Paradigm IT security requirement and policies.
  • Responsible for safeguarding Paradigm or Paradigm related IT passwords.
  • Responsible for notifying Paradigm of any IT security incidents per Policy No. 16 Information Security Incident Management.

PM19

. Requirements:

QUALIFICATION REQUIREMENTS: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


  • Education: Bachelors degree from an accredited educational institution preferred.
  • Experience: Two to five years progressively responsible customer service experience. Related experience in provider relations or health care preferred. Strong medical background preferred, including comprehensive understanding of medical terminology and health care principles and practices.
  • Demonstrated ability to multi-task in a fast paced work environment. Experience with various computer applications including Microsoft Office, Outlook, WORD and Excel.
  • Must demonstrate an ongoing willingness and ability to learn new database management programs.
  • Acute attention to detail.
  • Language: Excellent oral communication skills and phone presence. Ability to read and comprehend instructions, correspondence, memos, and medical/patient reports. Ability to write correspondence and memos and utilize e-mail communication effectively. Ability to present information in one-on-one and small group situations.
  • Reasoning Ability: Excellent analytical skills -- ability to define problems, collect data, establish facts, and draw valid conclusions; ability to interpret a variety of instructions and deal with abstract and concrete variables; demonstrated ability to analyze difficult situations, problems, and data; use good judgment and decision making.
  • Any combination of education/experience and knowledge that demonstrates the ability to perform the functions of the position will be accepted.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an

employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to

enable individuals with disabilities to perform the essential functions.

  • Physical Activities - While performing the duties of this job, the employee is regularly required to reach with hands and arms and talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand and walk.
  • Perform some repetitive motion activities (keyboarding, computer mouse use).
  • Weight Lifted/Force Exerted - The employee's job does not require weight to be lifted or force exerted.
  • Vision Requirements - Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an

employee encounters while performing the essential functions of this job. Reasonable accommodations may be

made to enable individuals with disabilities to perform the essential functions.

  • Environment Conditions - While performing the duties of this job, the employee does not work in wet or humid conditions (non-weather), work near moving mechanical parts, work in high, precarious places, endure outdoor weather conditions and/or endure extreme cold or heat (non-weather).
  • Noise Level - The noise level in the employee's work environment is usually quiet to moderate.

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