In collaboration with Care Coordination team members, this position provides support and guidance to HealthPlan members referred to the Care Coordination Department for Case Management services and programs. The Health Care Guide I works closely with members, families, providers, community agencies, and the interdisciplinary care team to assist in coordination of benefits in a timely and cost-effective manner, while connecting members to available internal and external resources.
The Manager of Clinical Quality and Patient Safety is responsible for managing key quality assurance and patient safety activities of the Quality Improvement Program. These include: Partnership HealthPlan’s facility site reviews and medical record reviews (Corporate lead), and potential quality issues and the peer review process (Northern Region lead). In addition, the Manager of Clinical Quality and Patient Safety serves as the Nurse Lead within the Northern Region QI department, providing clinical input and leadership across QI department programs and improvement projects.
*This is a temporary position.
To begin Treatment Authorization Requests (TAR) reviews and perform data entry upon TAR
determination by pharmacy staff. Performs eligibility and benefit investigations. Supports
pharmacy department with extracting and collecting data for reporting needs. Supports
department's administrative needs, and participates in special projects as assigned by pharmacy
technician lead, supervisor, and departmental staff.