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Hearings Coordinator in Scarborough at KEPRO

Date Posted: 9/3/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Scarborough
  • Job Type:
  • Experience:
    At least 2 year(s)
  • Date Posted:
    9/3/2018

Job Description

Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization. We are a leading quality improvement and care management organization. We offer innovative and outcomes-focused solutions to reduce the unnecessary use of health care resources and optimize the quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. KEPRO is on a journey to transform medical management and to develop customized solutions tailored to our client’s specific business requirements, while improving the quality of life for patients, reducing costs, and achieving return on investments for our clients. Our approach to medical management is holistic and compassionate and is coordinated around a patient’s entire healthcare experience.

Hearings Coordinator

Summary Description

The Hearings Coordinator provides management, oversight and direction to the Registration Coordinator and Consumer/Family Liaison teams regarding achievement of service deliverables.  The Hearing Coordinator provides supervision, coordinates inter-rater reliability functions, establishes team policies and procedures, monitors performance and provides reporting for applicable deliverables and functions.

Accountabilities

  • Provide operational oversight to the RC and CFL teams to ensure contract deliverables are achieved.
  • Identify, assess and provide management, oversight and training to staff related to their functions.
  • Develop and maintain operational guidelines for the department.
  • Develop, monitor and update protocols and train CFL staff on proper implementation of the Participant Experience Survey and customer service.
  • Develop, monitor and update protocols and train RC staff on proper review of requests for prior authorization, tracking 2nd level negotiations, attending hearings and customer service.
  • Fill in for staff when they are unavailable to complete task-at-hand.
  • Provide reporting of staff functions, deliverables.
  • Other duties as assigned.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

  • Applicants must have a minimum of a Bachelor’s Degree in a Human Service field (Master’s preferred).
  • RN, Social Worker or applicable clinical licensure preferred, Behavior Support Professional credential preferred.

Skills, Knowledge Abilities (SKA)

  • Applicants must have a working knowledge of Microsoft software and experience with I/DD Waiver CareConnection© is a plus.
  • Applicants must possess knowledge of the I/DD Waiver program policies and procedures, be organized and efficient and have effective professional written and verbal communication skills.
  • The chosen applicant must be flexible, willing to learn new skills and undertake new challenges and tasks, must be a self-starter and an innovator.

Experience       

  • A minimum of 2 years of experience in the West Virginia I/DD Waiver program and at least 2 years of prior leadership and /or supervisory experience.

Mental and Physical Requirements        

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 will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

Only those candidates identified for an interview will be contacted. No Phone Calls Please.  Visit our website at www.kepro.com for more information on the KEPRO Family of Companies.

EOE AA M/F/Vet/Disability

KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.