EH
Elevance HealthSenior Portfolio Manager
Portfolio Manager Senior overseeing complex project portfolios, ensuring alignment with budget objectives and operational goals at Elevance Health.
About the role
- Responsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes
- Acts as a resource to other team members including UR Tech and AA to support UR and revenue cycle process
- Utilizes Payer specific screening tools to assist in determination regarding level of service and medical necessity
- Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues
- Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers
- Appropriate and complete documentation of clinical review and denial management in the case management documentation system and in the billing system
- Manages the concurrent denial process by referring to appropriate resource for concurrent and retrospective appeal activity process
- Prepares and facilitates audits using appropriate screening tools and documentation
- Accountable to job specific goals, objectives and dashboards
- Participates in organizational improvement activities including patient satisfaction, Six Sigma committee, department and/or divisional teams and community activities
- Understands and applies applicable federal and state requirements and identifies and reports compliance issues as appropriate
- Remote work environment after successful completion of in-office training
Requirements
- RN required
- Licensure from the State of New Jersey as a Registered Nurse
- Graduate of an accredited School of Nursing (BSN strongly preferred)
- Case Management Certification (requirement within one year of hire beginning April 1, 2015)
- 3 years clinical nursing (RN) experience preferred
- 1 year UR/CM/QM experience preferred
- Basic understanding of Medicare, Medicaid and managed care
- Discharge planning or home health background
- Excellent verbal and written communication skills
- Problem solving, critical thinking and conflict resolution
- Ability to complete in-office training prior to remote work
Benefits
- Virtua offers a comprehensive package of benefits for full-time and part-time colleagues, including, but not limited to: medical/prescription, dental and vision insurance
- Health and dependent care flexible spending accounts
- 403(b) (401(k) subject to collective bargaining agreement)
- Paid time off
- Paid sick leave as provided under state and local paid sick leave laws
- Short-term disability and optional long-term disability
- Colleague and dependent life insurance and supplemental life and AD&D insurance
- Tuition assistance
- Employee assistance program that includes free counseling sessions
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