Managed Care Specialist (Hospice)

Description:

Job Summary:

The Managed Care Specialist is responsible for planning and implementing a networking and marketing strategy to the community and professional referral sources to generate qualified referrals. The Managed Care Specialist is also responsible for the accurate dissemination of information regarding the hospice benefit to the community, potential patients, and referral sources. This position is responsible for promoting a compassionate and credible image to the community for both themselves and ProCare Hospice of Nevada. _______________________________________________________________________________

Accountability:

Reports to the Admissions Director

Requirements:

Job Duties and Responsibilities:

Essential Job Functions:

• Fosters and maintains an effective working relationship between peers, professional staff, and other personnel within the community
• Has a solid understanding of basic hospice regulations, levels of care and admission criteria
• Remains up to date on both Federal and state regulations as they change and promptly educates referral sources to changes in the regulations when necessary
• Gathers data on patient referrals to assist with the admission process when requested
• Understands/teaches basic principles of hospice and palliative care within the agency scope of practice
• Demonstrates ability to problem-solve and make decisions by assessing situations and considering alternatives, seeking guidance and direction as necessary, utilizing proper chain of command
• Demonstrates effective time management skills by coordinating activities to achieve maximum productivity and efficiency, willingness to adjust or revise work schedules as requested
• Stays current with all mandatory agency and regulatory requirements
• Completes assigned projects within specified time frames
• Due to the autonomous nature of the position, this individual must be self-motivated with the understanding that they are required to work a minimum of a 40-hour work week
• Develops relationships with community and professional referral sources that result in qualified referrals
• Ensures that all marketing materials are up to date with current regulations regarding hospice and homecare
• Ensures that accurate information is disseminated to the community and potential referral sources
• Works with Admissions Coordinator to ensure that patient admissions are completed in a timely and accurate manner, which may include attending the admission, obtaining consents, obtaining attending physician certification of terminal illness and other admission duties to be assigned when necessary
• Plans for, and achieves, monthly goals for referral contacts and admissions
• Maintains a detailed book of business utilizing the provided CRM software to generate weekly reports and follow up ticklers
• Trains and “shadows” newly hired marketers in the proper use of the CRM system and how to develop and maintain their book of business
• Coordinates effective community education programs to increase community awareness on the hospice benefit, helping to generate qualified referrals
• Directs or assists with the coordination of community awareness events including health fairs, health care mixers and ProCare sponsored community events
• Maintains a positive attitude, energy, enthusiasm, initiative, fortitude, perseverance and follow-through with leads and referrals sources
• Able to make “cold calls” by telephone and in person
• Has the flexibility to work evenings, weekends, and extended hours to accommodate special events, last minute community referrals and other marketing responsibilities that come up, last minute
• Projects a professional, credible, compassionate image, maintaining above the line standards by only representing the positives of ProCare Hospice of Nevada and never indulging in or focusing on negative banter about other agencies, their employees or referral sources, even when it might be true
• Other duties as assigned

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Additional Functions:

• Adheres to patient rights, abuse reporting and confidentiality policies
• Attends scheduled staff meetings and or in-service training
• Adheres to the departmental dress code requirements related to personal grooming and attire
• Participates in Performance Improvement activities as requested
• Demonstrates reliability by making every attempt to report to work on time, providing proper notification for absence or tardiness and follows policies related to time off requests
• Assumes responsibility for on-going personal development and continuing education
• Seeks guidance from higher authority as needed
• In the case that a company credit card is issued, this position is required to maintain accurate spending logs, tracking receipts and reasons for purchases along with submitting these expenses as directed in a timely manner on the 15th and last day of the month

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Physical/Safety Requirements:

• Must have the strength and endurance required for standing and walking for lengthy periods of time
• Utilizes appropriate basic office equipment
• Uses appropriate body mechanics as needed
• Category 2 for potential exposure to blood/body fluids. (Does not usually require the performance of procedures or other tasks in the work routine that involve exposure to blood, body fluids or tissues, but Category 2 tasks may require the unexpected performance of these procedures)
• Utilizes appropriate Personal Protective Equipment (PPE) as required
• Follows the designated plan of action in the event of a fire or other emergency
• Must be able to travel throughout the territory to homes of prospects and professional businesses
• While performing the duties of this job, the employee is regularly exposed to fumes or airborne particles, work- related stresses, and driving hazards
• This individual may be required to drive to meetings with clients, health care professionals or patients
• The noise level in the work environment is usually minimal

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

In compliance with the Americans with Disabilities Act of 1990, the employer will provide reasonable accommodations to meet the work environmental and physical demands listed above.

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Qualifications and Experience:

• Must be an experienced sales professional, where relationship-building skills (listening, understanding, helping to identify appropriate solutions, and closing) have been proven
• A minimum one year of experience is preferred in hospice care, to assure understanding of hospice care and the overall continuum of care for hospice patients
• Must have reliable transportation, a valid driver’s license, and current auto insurance
• Must possess ability to communicate verbally with potential patients and referral sources
• Must be flexible in meeting evenings and weekend requirements
• Must successfully completion of Background check pursuant to NRS 449.188 and NRS 179A.100, verification of previous employment, references and driving history (MVR), (may also include verification of education)
• Must be able to read, speak, write, and understand the English language
• Must be able to handle frequent interruptions
• Must be able to cope with emotionally charged situations encompassing patients, families, and other caregivers
• Must be able to work independently and effectively managing time for maximum results