Subject Line: Application x Part-Time Care Coordinator/UM Specialist (5-10Hrs Per Week)
SEND YOUR CV TO:

• recruitment@inovacare.com

Why Join Us?
Collaborative Environment
Join a team of experienced healthcare professionals dedicated to improving patient outcomes. Our flat organizational structure promotes open communication and continuous learning, helping you feel supported and integral to our mission.
Career Development
We offer flexible part-time positions with the potential to expand to full-time, allowing you to balance work and personal commitments while advancing your career.
Benefits:
Professional Growth
Opportunities for professional development and learning are readily available, as is the possibility to contribute to industry publications.
Supportive Work Culture
We prioritize creating a supportive and inclusive workplace where every team member can thrive.
Key Qualifications

• Must possess a valid RN license, ensuring adherence to national medical standards.
• We value clinical nursing experience in areas such as medical-surgical, home health, or telehealth, equipping you to manage a diverse patient population.
• At least 1 year of experience in Remote Patient Monitoring.
• Proficiency in digital health platforms and remote communication technologies is essential for effective patient interaction and care delivery
• Excellent communication skills in English are crucial to enhance patient interactions across diverse patient communities.
• Strong critical thinking and problem-solving abilities are required to effectively navigate the complexities of remote healthcare.
• Ability to work independently and collaborate effectively within a remote team environment is essential for seamless care coordination.
• A deep commitment to compassionate and patient-centered care, driven by a desire to positively impact patients’ lives.
• Familiarity with disease management protocols and evidence-based practice guidelines ensures high standards of care.
• Demonstrated understanding of clinical pathways and utilization management processes.
• Familiarity with claim adjudication processes, including authorization, review, and processing.
• Knowledge of Hospital Revenue Codes, ADA, ICD9, ICD10, HCPCS, and CPT4 procedure coding.
• Experience with case management and care coordination.
• Proven ability to evaluate medical necessity and appropriateness of treatments and claims.

Responsibilities:
Care Coordinator
Patient Assessment and Monitoring: Conduct detailed assessments of patients remotely, monitor health conditions, and coordinate findings with overseeing healthcare providers.
Documentation Excellence: Ensure thorough and accurate record-keeping within digital platforms, keeping patient data up-to-date and accessible.
Informative Patient Care: Develop and implement tailored care and monitoring plans based on individual patient needs, while also providing vital education on managing chronic conditions and preventive care measures.
Collaborative Healthcare Delivery: Work closely with healthcare professionals to ensure comprehensive patient care and continuity of services.
Patient Support: Provide empathetic support and guidance to patients and their families throughout their healthcare journey, enhancing their overall experience.
Program Improvement: Participate in the development and quality enhancement of our remote monitoring program, contributing to the continuous improvement of our services.
UM Specialist:

• Conduct authorizations for outpatient, inpatient, emergency, elective, non-elective (emergency), dental, and health screening procedures based on medical necessity, medical appropriateness, benefit coverage, and member eligibility.
• Provide prior-authorization and authorization support for inpatient admissions as well as select treatments or providers requiring prior-authorization before treatment(s) can be rendered.
• Evaluate all authorization, concurrent, and retrospective reviews on the basis of medical necessity and medical appropriateness using international clinical pathways.
• Make medical necessity and medical appropriateness determinations for health and dental claims.
• Determine benefit liabilities based on medical necessity, benefit level, member eligibility, waiting periods, pre-existing conditions, exclusions, and coverage.
• Provide input and advice to claims and customer care teams regarding medical necessity and medical appropriateness evaluations.
• Conduct concurrent review, case monitoring, and discharge planning for all inpatient admissions based on international clinical pathways and specific client requirements.
• Engage in coordination of care and treatment planning for eligible members requiring additional assistance.
• Work with claims team on fraud and abuse detection programs.
• Work with the product development team and senior management to contribute insights from utilization management to help shape new products and improve existing ones, ensuring they address market demands and optimize claim expenses.
• Ensure that all utilization management programs are documented and comply with the company’s overall Quality Management Guidelines.
• Work with provider relations and provider network on use and compliance with international clinical pathways, as well as any locally adapted business rules.
• Ensure all case reviews are done within the company’s turnaround time and service level requirements.
• Work with hospital and clinic personnel to ensure appropriate and timely discharge planning.
• Issue final guarantee letters to hospitals outlining payment responsibilities prior to member discharge.
• Support customer service-related tasks, especially for patients, providers, or clients asking about benefit clarification or claim status.
• Other tasks in support of the company’s utilization management-related and business objectives.

If you're ready to make a meaningful impact in a dynamic field, we would love to hear from you. Join us in redefining patient care through innovative technology and compassionate service. If you're ready to help drive the future of healthcare and make a substantial impact in the lives of patients, we encourage you to apply today.
Job Type: Part-time
Benefits:

• Flexible schedule

Application Question(s):

• How many years of experience do you have in remote patient monitoring?
• What is your expected salary?
• How flexible is your schedule?

Experience:

• Nursing: 1 year (Required)

License/Certification:

• RN License (Required)