Patient Access Representative Salary in Tampa, FL

Description Nurse Medical Management Sr -Medicaid (JR107109) Location: Must reside within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This is primarily a remote position but may be required to go in for meetings/training. MUST RESIDE IN THE STATE OF FLORIDA. Work Hours: 8am - 5pm, Monday - Friday. 2 Holidays per year and occasional weekends. The Nurse Medical Management Sr serves as team lead for nursing staff who collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for the most complex or elevated medical issues. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but are not limited to: Continued stay review, care coordination, and discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Conducts precertification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Ensures member access to medical necessary, quality healthcare in a cost-effective setting according to contract. Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost-effective care throughout the medical management process. Collaborates with providers to assess members needs for early identification of and proactive planning for discharge planning. Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications. Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards. Ensures consistency in benefit application. May lead cross-functional teams, projects, initiatives, and process improvement activities. May serve as departmental liaison to other areas of the business unit or as representative on enterprise initiatives. Assigns and audits daily work of other nurses. Functions as a SME for the team. Minimum Requirements: Current active unrestricted RN license in the state of Florida. Requires minimum of 5 years acute care clinical experience, utilization management or managed care experience; or any combination of education and experience, which would provide an equivalent background. Preferred Qualifications: Experience working in health insurance industry. 2 years of experience in In-Patient, utilization management, evaluating medical necessity for services and procedures within the managed care industry. Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products. Experience leading, mentoring, coaching others, with, or without, direct reports. Experience with the Medical Review process within Medicaid or Medicare Managed Care. Proficient in use of Microsoft Word, Excel, and Outlook. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] assistance.

Siemens Healthineers' PETNET Solutions stands at the forefront of the global PET radiopharmaceutical industry, embodying excellence and unparalleled expertise. Our commitment to the consistent and timely delivery of premium-quality radiopharmaceuticals and services has solidified our reputation as the premier partner in PET imaging since our inception in 1996. Operating more than 47 facilities worldwide, Siemens Healthineers PETNET Solutions is recognized as the largest provider of positron emission tomography (PET) radiopharmaceuticals. Annually, we distribute over 1,000,000 doses to in excess of 2,800 imaging centers globally. To date, our network has successfully delivered over 6,000,000 doses across the globe since 1996. Our extensive pharmacy network, the largest of its kind, ensures unparalleled reliability, with a dose fulfillment rate exceeding 99%. Our system's robustness guarantees the successful dispensation of orders, epitomizing our commitment to reliability and confidence in service. Discover more about our capabilities at Siemens Healthineers PETNET Solutions . We pride ourselves on offering comprehensive on-the-job training conducted by our world-class training team based in Knoxville, TN. New hires undergo a rigorous five-week program, combining in-person and virtual learning, meticulously designed to cultivate the necessary skills for success within our pharmacy operations. Full-time employees at PETNET Solutions, a Siemens Healthineers company, enjoy a comprehensive benefits package. This includes medical, dental, and vision insurance, a 5% annual bonus plan, a 100% match on 401K contributions, and 20 days of paid time off annually, in addition to 5 floating holidays. Shift: Please note that this is primarily a night shift position at the PETNET Solutions pharmacy; flexibility to work alternative shifts is required, including weekend rotations. State of Florida Licensed Pharmacy Technician preferred This is a role well suited to an ambitious professional, looking for the next step in their career. As a Lab Production Technician, you will be responsible for: You will perform complex compounding, manufacturing (cyclotron and chemistry module operation) and quality control processes (utilizing analytical equipment TLC, HPLC, GC), under supervision as required by State and Federal law. You will participate in complex inspections, maintenance and troubleshooting to support manufacturing and testing processes and equipment. You will implement approved SOP changes to production and quality control processes. You will be involved in Daily, Weekly, Monthly, and Quarterly PM checks of Cyclotrons, Chemistry Modules, and QC Equipment as per the SOP's You will oversee routine logistics functions including preparing product for shipment, coordinating courier schedules, and documenting as necessary. This position may suit you best if you are familiar with what is below, and would like to do develop your career with Healthineers: Analytical Chemistry Equipment and Processes (HPLC, GC, TLC) Experience working in a sterile or clean room laboratory/environment. Required skills to have for the success of this role: You are detail oriented and have strong critical thinking skills. You can work well independently. You have basic computer skills such as spreadsheet, word processing and e-mail. You have strong verbal and written communication skills. You can lift up to 100Lbs You are willing to work night shifts and alternating shifts as needed. Who we are: We are a team of more than 71,000 highly dedicated Healthineers in more than 70 countries. As a leader in medical technology, we constantly push the boundaries to create better outcomes and experiences for patients, no matter where they live or what health issues they are facing. Our portfolio is crucial for clinical decision-making and treatment pathways. How we work: When you join Siemens Healthineers, you become one in a global team of scientists, clinicians, developers, researchers, professionals, and skilled specialists, who believe in everyone's potential to contribute with diverse ideas. We are from different backgrounds, cultures, religions, political and/or sexual orientations, and work together, to fight the world's most threatening diseases and enable access to care, united by one purpose: to pioneer breakthroughs in healthcare. For everyone. Everywhere. Sustainably. Beware of Job Scams Please beware of potentially fraudulent job postings or suspicious recruiting activity by persons that are currently posing as Siemens Healthineers recruiters/employees. These scammers may attempt to collect your confidential personal or financial information. If you are concerned that an offer of employment with Siemens Healthineers might be a scam or that the recruiter is not legitimate, please verify by searching for the posting on the Siemens Healthineers Career Site . "Successful candidate must be able to work with controlled technology in accordance with US export control law." "It is Siemens Healthineers' policy to comply fully and completely with all United States export control laws and regulations, including those implemented by the Department of Commerce through the Export Administration Regulations (EAR), by the Department of State through the International Traffic in Arms Regulations (ITAR), and by the Treasury Department through the Office of Foreign Assets Control (OFAC) sanctions regulations." As an equal opportunity employer, we welcome applications from individuals with disabilities. We care about your data privacy and take compliance with GDPR as well as other data protection legislation seriously. For this reason, we ask you not to send us your CV or resume by email. Please create a profile within our talent community and subscribe to personalized job alert that will keep you posted about new opportunities. To all recruitment agencies: Siemens Healthineers' recruitment is internally managed, with external support permitted only when a qualified supplier has established a formal contract with us. Unsolicited candidate submissions and referrals, absent a current supplier contract, do not establish consent and are ineligible for fees. We delete and destroy unsolicited information, thus, would recommend you refrain from any such practices. Your adherence to our policies is appreciated. #LI-AW1 #PETNET Equal Employment Opportunity StatementSiemens is an Equal Opportunity and Affirmative Action Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to their race, color, creed, religion, national origin, citizenship status, ancestry, sex, age, physical or mental disability unrelated to ability, marital status, family responsibilities, pregnancy, genetic information, sexual orientation, gender expression, gender identity, transgender, sex stereotyping, order of protection status, protected veteran or military status, or an unfavorable discharge from military service, and other categories protected by federal, state or local law. Reasonable AccommodationsIf you require a reasonable accommodation in completing a job application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please fill out the accommodations form by clicking on this link Accomodation for disablity form If you're unable to complete the form, you can reach out to our AskHR team for support at 1-866-743-6367. Please note our AskHR representatives do not have visibility of application or interview status. EEO is the LawApplicants and employees are protected under Federal law from discrimination. To learn more, Click here .Pay Transparency Non-Discrimination ProvisionSiemens follows Executive Order 11246, including the Pay Transparency Nondiscrimination Provision. To learn more, Click here .California Privacy NoticeCalifornia residents have the right to receive additional notices about their personal information. To learn more, click here .

Location: Req Number: Req #1024Date Posted: Friday, April 19, 2024Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. SUMMARY: Responsible for Contact Center activities and team management. Responsible for overseeing and managing the daily operations of the Contact Center. The Contact Center Manager will ensure that the team consistently delivers high-quality service to our customers, meets performance targets, and maintains a positive and productive work environment in a variety of functions, such as inbound provider calls, outbound calls to providers, voicemails, and e-mail queue management. Seeking a candidate with strong contact center/call center management and supervisory experience.DUTIES AND RESPONSIBILITIES:Provide leadership and guidance to the Contact Center team, including supervisors and agents.Oversee daily call center operations to ensure smooth workflow and optimal resource utilization.Manage staffing levels, scheduling, and resource allocation to ensure adequate coverage and optimal utilization of resources across multiple queues.Utilizing workforce management techniques, forecast staffing needs and adjust schedules as necessary to meet demand.Responsible for auditing and approving timesheets, and monitoring and holding team accountable for attendance.Establish, track, analyze, and report on key performance indicators (KPIs) to measure team performance and identify areas for improvement.Develop and implement strategies and initiatives to optimize efficiency, productivity, and customer satisfaction.Collaborate with cross-functional teams to optimize contact center processes and enhance customer/client satisfaction.Implement performance improvement plans when necessary and track progress.Establish and maintain quality assurance standards to ensure that customer interactions meet or exceed company standards.Participate in and/or conduct regular quality assurance assessments on customer interactions to ensure adherence to company policies and procedures. Provide coaching and feedback to team members to enhance their quality, skills, and performance.Develop and implement training programs to onboard new team members and enhance the skills of existing staff.Identify and address training needs based on performance gaps.Assist Contact Center in answering phone calls during excessively high periods of volume.Perform additional support functions as needed.Responsible for complying with Paradigm IT security requirement and policies.Responsible for safeguarding Paradigm or Paradigm related IT passwords.Responsible for notifying Paradigm of any IT security incidents per policy 16.0 Information Security Incident Management. SUPERVISORY RESPONSIBILITIES: Mentor, train, and supervise team members directly and indirectly, review their work and provide effective constructive feedback.Ensure all team members understand, are trained in, and comply with Paradigm’s security requirements and policies.Ensure all team members have the minimum level of IT system access required to effectively complete their Paradigm responsibilities. QUALIFICATION REQUIREMENTS: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Education/Training: Bachelor’s degree in a related field (e.g., Health Care Administration, Business, or Science) preferred. Commensurate experience may be considered in lieu of a completed bachelor’s degree.Experience: At least 5 years in as a manager/supervisor in a high-volume call center environment. Workers Compensation or Healthcare experience preferred, though not required.Skills: Excellent communication skills, verbal and written. Excellent organizational and prioritization skills, with ability to multi-task; strong problem solving and decision-making skills.Equipment/Machinery: Excellent computer skills (e.g., Outlook, Teams, to be trained on proprietary software); standard office equipment including phones, scanners, fax, laptop/PC, copiers, various computer programs, etc. Proficient in contact center software and telephony systems.Able to cooperate and work cohesively with all co-workers, management, and external customers. Able to plan and complete job duties with minimal supervisory direction, utilize sound judgment, tact, diplomacy, and compassion in verbal and written communication.Ensure confidentiality of all data, including injured worker’s demographics, employee, and operations data.Able to complete requirements for in-service training, maintain acceptable attendance and appropriate dress code.PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Physical Activities: While performing the duties of this job, the employee is regularly required to reach with hands and arms, and to talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand and walk.Weight Lifted/Force Exerted: The employee's job does not require weight to be lifted greater than 20 pounds.Vision Requirements: Specific vision abilities required by this job include close vision and the ability to adjust focus.WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Environment Conditions – Office environment with office level ambient noise and conditions. While performing the duties of this job, the employee does not work in wet or humid conditions (non-weather), work near moving mechanical parts, work in high, precarious places, endure outdoor weather conditions or endure extreme cold or heat (non-weather).Noise Level – Will be low to moderate noise found in typical office environments. Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Other detailsJob Family ActivePay Type SalaryMin Hiring Rate $75,000.00Max Hiring Rate $90,000.00PI239793017