MCS Puerto Rico
Join to apply for the Special Needs Plan Program Specialist role at MCS Puerto Rico
5 days ago Be among the first 25 applicants
General Description Performs health risk assessments (HRA’s) to determine if the member is eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI). Reviews the member's individualized care plan and performs specific interventions to monitor the member's health status.
Performs Health Risk Assessments for all members referred for Special Supplemental Benefits for the Chronically Ill (SSBCI) within the established time frame.
Makes telephone calls to the most vulnerable population to monitor the health status and the member's compliance with his or her individualized care plan.
Alert in case of identifying deficiencies or opportunities for improvement to guarantee the clarity of the processes.
Contacts members by phone to complete assessments and provide appropriate referrals.
Contacts physicians to complete member assessments in cases where additional medical information is needed from the member.
Identifies potential cases for appropriate intervention by the corresponding area.
Receives and appropriately directs incoming calls from members and physicians.
Manages any situation from physicians or a member to be promptly referred to complete the Health Risk Assessment.
Communicates the assessment's final determination according to departmental policies and procedures and within established time parameters.
Maintains reports and productivity metrics as requested.
Complies with production, quality, and timelines as required per applicable regulations.
Must comply fully and consistently with all company policies and procedures, local and federal laws, and regulations applicable to our Industry.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
Regular
Exempt
Essential Functions The essential functions are identical to the responsibilities listed above.
Minimum Qualifications Education and Experience: Bachelor of Science in Nursing (BSN). Minimum of three (3) years of experience in clinical areas, including documentation or analysis of health conditions.
Certifications / Licenses: Valid License and Registration for Nursing Practice in PR.
Other: N/A
Languages
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and takes affirmative action to recruit Protected Veterans and Individuals with Disabilities. MCS is a participating E-Verify employer.
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Other
Industry Insurance
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5 days ago Be among the first 25 applicants
General Description Performs health risk assessments (HRA’s) to determine if the member is eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI). Reviews the member's individualized care plan and performs specific interventions to monitor the member's health status.
Performs Health Risk Assessments for all members referred for Special Supplemental Benefits for the Chronically Ill (SSBCI) within the established time frame.
Makes telephone calls to the most vulnerable population to monitor the health status and the member's compliance with his or her individualized care plan.
Alert in case of identifying deficiencies or opportunities for improvement to guarantee the clarity of the processes.
Contacts members by phone to complete assessments and provide appropriate referrals.
Contacts physicians to complete member assessments in cases where additional medical information is needed from the member.
Identifies potential cases for appropriate intervention by the corresponding area.
Receives and appropriately directs incoming calls from members and physicians.
Manages any situation from physicians or a member to be promptly referred to complete the Health Risk Assessment.
Communicates the assessment's final determination according to departmental policies and procedures and within established time parameters.
Maintains reports and productivity metrics as requested.
Complies with production, quality, and timelines as required per applicable regulations.
Must comply fully and consistently with all company policies and procedures, local and federal laws, and regulations applicable to our Industry.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
Regular
Exempt
Essential Functions The essential functions are identical to the responsibilities listed above.
Minimum Qualifications Education and Experience: Bachelor of Science in Nursing (BSN). Minimum of three (3) years of experience in clinical areas, including documentation or analysis of health conditions.
Certifications / Licenses: Valid License and Registration for Nursing Practice in PR.
Other: N/A
Languages
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and takes affirmative action to recruit Protected Veterans and Individuals with Disabilities. MCS is a participating E-Verify employer.
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Other
Industry Insurance
#J-18808-Ljbffr