Job Number: 20015394

Location: Brentwood, TN

Date Posted: 5-15-2017

Job Title: Anchor Team Specialist

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Why naviHealth?

naviHealth is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time. How might you ask? By hiring talented clinicians, engineers, analysts, and healthcare leaders to create and utilize cutting edge technology to provide the patient with the best level of care for the right amount of time.

Why Is This Role Critical?

The Anchor Team Specialist will orchestrate the workflow of a geographically-centered multi-disciplinary clinical team throughout the full continuum of care managed/followed by naviHealth, allowing clinical colleagues to increase their focus on clinical evaluation and decision making. The Specialist will provide clinical documentation oversight for pre-service and concurrent review requests for assigned colleagues to ensure timely response and service delivery excellence. The role will facilitate engagement with the team members to ensure alignment of expectations and assignments, and optimize team performance recognizing varying daily requirements and provider requests of naviHealth. This role will regularly engage with provider stakeholders to ensure timely receipt of adequate and time sensitive clinical documentation and will educate key provider contacts on documentation requirements when necessary. The Specialist will actively seek to develop effective and respected relationships with key provider contacts, market stakeholders as well as team members and colleagues. The ATS will coordinate with centralized naviHealth resources to ensure the data integrity and regulatory compliance of the clinical documentation for clinical determinations, recommendations and closure of the medical record in the naviHealth database. Success will be measured by proactive receipt of adequate clinical documentation and delivery to clinical colleagues for completion of LiveSafe™, Interqual® and other assessments to ensure timely clinical determinations and recommendations as well as completeness and closure of the medical record. Additionally, this role will be accountable for reporting and escalating any grievance, compliance and/or regulatory concerns that may arise throughout the continuum of care supported by the assigned multi-disciplinary team.

What you will be accountable for….

  • Maintains expert knowledge of all applicable client processes, queues, and specific contract requirements that impact the utilization management, care coordination, and convener service delivery
  • Facilitates daily communication between multi-disciplinary team members regarding determinations, recommendations and upcoming needs to ensure smooth coordination and warm transfer of member/beneficiary utilization and care coordination
  • Evaluates the adequacy of the clinical documentation before progressing through the clinical process to ensure timely review and service delivery and engages with key provider contacts when clinical information is lacking or supporting documentation is required.
  • Proactively manages daily and weekly caseload assignments for clinical team members and will coordinate with leadership and other teams when overflow assistance is required
  • Reviews care team caseloads daily to proactively identify upcoming reviews and requests required documentation and validates receipt in a timely manner
  • Determines adequacy of clinical documentation, accuracy of database documentation and the completeness of the medical record and naviHealth databases as defined by quality and service standards
  • Coordinates with colleagues to align expectations and identify exceptions to standard expectations for daily care coordination and/or utilization management activities based on assigned caseloads of the clinical care team
  • Actively engages with key provider contacts to ensure adequate knowledge and understanding of clinical documentation requirements for determinations, LiveSafe completion, OPT delivery and records closure
  • After exhausting common solutions, escalates concerns with timeliness, demand exceeding capacity or other performance limiting factors to leader for assistance with resolution
  • Escalates issues prohibiting or restricting service standards regarding but not limited to technology, resources, and compliance concerns to designated leadership and all appropriate naviHealth resources
  • Informs designated naviHealth personnel when there are regulatory or contractual discrepancies or omissions in the medical record or naviHealth databases
  • Ensures the multi-disciplinary team service delivery meets all contractual and regulatory timeliness requirements and escalates concerns to appropriate leadership
  • Develops relationships with key internal customers such as market operational, network and clinical leaders as appropriate
  • Adheres to organizational, departmental and regulatory policies and procedures
  • Evaluate and make recommendations to leadership to improve processes in conjunction with defined process improvement structure
  • Attends naviHealth meetings as requested
  • Promotes a positive attitude and work environment
  • Performs all other duties as assigned

What you will need to be successful……

  • Bachelor’s Degree from an accredited college preferred.
  • Degree from an accredited college / professional clinical program combined with 3 – 5 years of recent experience in healthcare related field required.
  • Experience in a post-acute care setting or a medical office servicing a post-acute population preferred.
  • Knowledge of CMS guidelines and regulations as well as common medical terminology.
  • Interpersonal skills with the ability to participate as an independent contributor in a fast-paced environment with autonomous problem identification/resolution and decision making capacity.
  • Ability to interact professionally and effectively with providers, physicians, and associates from all departments within and outside naviHealth.
  • Creative thinking and problem solving experience with the ability to consider impacts of decisions or actions.
  • Ability to ask the needed bigger-picture questions that lead to process and team improvements.
  • Analytical and interpretation skills including departmental, utilization, financial and operations data a plus.
  • Strong precise and concise written and verbal communications skills
  • Ability to prioritize, plan, and manage multiple competing tasks/demands for multiple colleagues
  • Proficient with Microsoft Office applications including Word, Excel and Power Point.
  • Able to use various office equipment, such as: copier, fax machine, telephone and scanner
  • Bilingual a plus.

About Us

naviHealth is a pioneer in post-acute care and care transitions with a combined unprecedented 18 years of experience that uniquely positions us to manage patients, improve clinical and financial outcomes, and share risk with payors and providers. As a Cardinal Health company, we provide clinical support alongside scalable technology and advisory solutions that empower health systems, health plans, and post-acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes

naviHealth Values

We care about the people we serve.

We care about each other.

We care about our communities.

We embrace innovation.

We like simple.

naviHealth ™ is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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