Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.
We don't believe in jobs at Mercy, we believe in careers that match the unique gifts of unique individuals; careers that not only make the most of your skills and talents, but also your heart.
At Mercy, you'll feel our supportive community every step of your day, especially the tough ones. We're a team and love working that way. That team is expanding, and we currently have exceptional opportunities to help our communities grow.
The Medical Management Specialist is responsible for supporting the functions of the clinical staff in Mercy Care Management (MCM) including but not limited to: development of tools to assist with reporting, analysis of patient data, research of medical topics, preparation of patient correspondence, and completion of special projects. The Medical Management specialist will help in preparation of audits and quality improvement activities, data entry, maintenance of statistical data, and reporting. The Medical Management Specialist may support activities relating to benefits and utilization determinations. The Management Specialist does not use scripts, perform any job functions related to assessment or interpretation of clinical information, nor do they make clinical decisions or populate clinical data fields in template assessment forms. In communicating with patients, plan members, coworkers, providers, and outside agencies, a caring, friendly, personal, and professional approach is expected. The co-worker in this position shall carry out his/her responsibilities in the Mercy philosophy of caring for the sick and suffering, respect for human life, and the dignity of each person, applying Christian values to all crucial human issues. The Medical Management Specialist works under the supervision of the MCM Management Staff and in close coordination with the MCM Medical Directors and performs related duties as assigned. The Medical Management Specialist performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards. Clinical staff will provide input on performance of the Medical Management Specialist to the MCM Management Staff.
Develop and maintain a system for collecting, coordinating, recording, and retrieving information required to complete the research for negotiations and determinations.
Collect and research hospital records, coding manuals, nationally approved criteria, medical internet websites and other forms of information to provide support for clinical staff to make effective and accurate decisions concerning the approval of medical services.
Works with physicians, outside agencies, and staff as needed top obtain additional information regarding the medical necessity of specialized medical services. Compose type and mail appropriate correspondence using professional medical terminology and medical director input as provided and required.
Develop and maintain reporting tools and formats for special projects, medical research, out of network contract analysis and other department activities as requested.
Coordinates research planning and development. Summarize conclusions of research analysis. Assists with the technical process of a health plan onsite and offsite audit, arranges meeting rooms, catering, and coordinates mailing/courier pickup, prepares records for offsite reviews, and types, secures appropriate signatures, and mails letters.
Work with medical directors and staff to provide research education and follow-up. Work with care management nurses, as indicated, to provide them with research information and maintain reference manuals.
Maintain reports relating to implementation, coordination, and follow-up of research and special projects. Develop, implement, and coordinate focus studies as indicated.
Provide staff in-services for Health Plans Medical Management coworkers under the supervision of the Director.
Assist the Director(s) with quality improvement activities and maintain current quality improvement document. Maintain network provider listings and update same for the Health Plans Medical Management Department. Act as liaison to Provider Relations Department for contracted Plan as needed.
Educate Health Plans Medical Management Department coworkers regarding services available with in the network under the direction of the Director(s).
Observes universal precautions consistently, and wears proper personal protective equipment when appropriate. Wears clothing and Health System badge consistent with dress code, and attends to personal hygiene to maintain a clean, well-groomed appearance.
Meets Health System attendance standards. Performs additional duties as assigned.
We're all unique pieces of a puzzle at Mercy, connected together to create a beautiful picture of health. And being the perfect fit for your role requires a specific set of qualifications that you'll bring with you:
Qualification 1: High School Diploma
Preferred Education: 1-2 years of college, or degree completion.
Preferred Experience: 2-3 years of experience in a medical setting including knowledge of medical terminology.
Other: Skills, Knowledge, and Abilities: Incumbent must possess excellent oral and written communication and highly developed organizational skills. Excellent investigative, fact-finding, and problem solving skills are needed. Intermediate to advanced computer skills, especially with windows, Microsoft Office applications, Must be capable of quickly learning other computer applications as needed. Must be detail oriented and able to perform multiple tasks successfully in a fast-paced setting. Equipment Used: Computer, fax machine, copier, and other office equipment as needed.
We'll Support You at Work and Home
Our foundations are built on dignity and respect. Modern Healthcare Magazine named us as a \"\"top 100 places to work.\"\" We go out of our way to help people feel welcomed. We offer day-one comprehensive health, vision and dental coverage, PTO, and employer-matched retirement funds, even to part-time employees. We're proud to provide tuition reimbursement to help you grow and learn new skills.
What Makes a Good Match for Mercy
Compassion and professionalism go hand-in-hand with us, along with exceptional quality care. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We're also collaborative and are not afraid to do a little extra to deliver excellent care - that's just part of our commitment. If that sounds like a fit for you as well, we encourage you to apply.
Transforming the Health of Our Communities.
Mercy, named one of the top five large U.S. health systems in 2017 by Truven, an IBM Watson Health company, serves millions annually. Mercy includes 43 acute care and specialty (heart, children s, orthopedic and rehab) hospitals, more than 700 physician practices and outpatient facilities, 40,000 co-workers and more than 2,000 Mercy Clinic physicians in Arkansas, Kansas, Missouri and Oklahoma. Mercy also has outreach ministries in Arkansas, Louisiana, Mississippi and Texas.
Associated topics: care, clinic, family, family practice, physician, physician md do, practice, practice physician, primary, primary care
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.