Clinical Vendor Liaison

Horizon Healthcare Services•Hopewell, NJ

13h

About The Position

This position serves as Horizons on-site clinical representative at the vendor location(s) or Horizon office based representative working collaboratively with the vendor management staff to ensure that exceptional service is provided to the customer. The incumbent facilitates the day to day coordination of the vendor(s) customer service clinical operations with Horizons clinical operations.

Requirements

High School Diploma/GED required.
Requires professional certification in a clinical specialty and least three years experience as a case manager.
Requires four (4) years acute healthcare experience
Requires a current license as a Registered Nurse or certification in Social Work.
Requires current licensure in the professional discipline appropriate to the case management.
Requires knowledge of Case Management/Disease Management Standards of Practice.
Requires knowledge of health care systems and medical documentation.
Requires understanding of claims processing, contracting and enrollment.
Requires knowledge of State and Federal Mandates and Regulations including HIPAA and HCQA.
Ability to express thought clearly and concisely both orally and written.
Ability to effectively lead team members without direct authority in diversified tasks.
Excellent organizational skills.
Proven time management skills with the ability to manage multiple priorities.
Exercise sound judgment and strong problem solving skills.
Must be client focused with effective ability to empathize.
Requires up to 75% domestic and international travel.

Nice To Haves

Bachelor degree in a health related field preferred or relevant experience in lieu of degree.
Prefers three (3) years experience as a supervisor.
Prefers (3) years managed health care experience.

Responsibilities

Acts as the clinical liaison between Horizon and the vendor to address day to day operational issues.
Identifies and implements process improvements targeted to improve clinical operational efficiencies and delivery of customer service.
Coordinates the delivery of clinical training and education to the vendor to ensure adherence to Horizon business and compliance requirements.
Requests and evaluates Corrective Action Plans (CAP) for adequacy, works with vendor on required changes, communicates approval of CAP to the vendors, and monitors open CAP.
Coordinates clinical guidance, coaching, refresher training and instructions to the vendor staff in order to improve performance.
Standardizes workflows and business processes to ensure compatibility between the Plan and Vendor teams to increase efficiencies.
Prepares status reports to keep Horizon management team apprised of daily operations, progress and issues.
Assists in the timely resolution of escalated member issues.
Facilitates the resolution of system problems, creating and tracking P-logs and escalate when required
Facilitates meetings/workgroups to drive issue resolution and process improvements.