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To help these companies imaginative and prescient vision, and also the Association comes legitimate; State of South Carolina will be open regarding fresh place seeing that Program Coordinator II throughout Richland County begin as October 2017. Everybody who’s thinking about completing this kind of nonincome producing, you should engage in this particular Program Coordinator II October 2017 recruitment within Richland County. It really is recommended to organize for all members, the many essential just for this employment recruitment method, to give for the reason that the method need someone with the appropriate standards, which the organization would like to through this situation. If you are, you a, you may load the options that you can try to see other information about Program Coordinator II October 2017 in Richland County below.
Serves as the lead employee with the Agency's Pharmacy Lock-In Program. Manages and maintains the Lock-In Program, the case files and logs. Identifies possible candidates, analyze recipient data for successful candidate selection and prepare letters to MCO's, recipients and pharmacies regarding the program. Answers calls and assists the lock-in candidate FFS recipient with questions and forward candidate MCO recipients to the appropriate contact when necessary. Works in conjunction with the pharmacy contractor to assure the recipient is locked into the selected pharmacy. Maintains and tracks program membership for both FFS and MCO members, handle transfers from one Medicaid program to another while maintaining Lock-In membership, and subsequently coordinate proper and timely exit from program. Prepares reports that successful describe program status for management and MCO consumption. Maintains and updates Lock-In Program Policies and Procedures as necessary. Ensures all policy properly reflects relevant federal and state regulation and that published policy is consistent with all written and disseminated policy and procedure. Translates policy successfully into work instructions that impact Agency department employees as well as MCO employees in the conduct of the Lock-In Program. Addresses how MCO's will interact among themselves when a loci-in member is transferring membership from one MCO plan to another. Maintains policy on how the Pharmacy Payment Manager will interact with the Lock-In Program and distinguish the FFS members from MCO members. Maintains and improves upon policy for determining the efficacy and cost savings of the Lock-In Program with a goal of establishing member outcome criteria for determining clinical success. Cross-trains on all functional areas of the Department of Recipient Utilization. Provides coverage for the Fraud Hotline as necessary and record calls in the daily complaint log and directs non-fraud calls to the appropriate areas within agency and external agencies. Works the complaint to determine the validity of the allegation. Processes cases for supervisor review and potential referral to other areas, agencies and MRFU. Opens and enters new referrals in Case Management, prepares letters, runs DCRs and contacts case workers as needed. Negotiates settlements with recipients and coordinates with our Fiscal Department when overpayments are discovered. Utilizes DataProbe to run reports that identify Lock-In candidates and work with DataProbe developed recipient Predictive Modeling that helps to identify Recipients that are most likely to have committed fraud/waste or abuse of Medicaid services. Uses Advantage Suite and other systems to create, run and analyze DCR's for recipients and providers as needed by both PI and MRFU staff. Demonstrates proficiency in retrieving and analyzing information obtained through MEDS and MMIS and other data systems.
Minimum and Additional Requirements:
A bachelor's degree and relevant program experience.
Must have and maintain a valid driver's license.
Sitting or standing for long periods of time.
Experience and knowledge of Medicaid Eligibility. Thorough knowledge of health care trends, drug utilization and terminology. Working knowledge of MMIS, SURS and desktop computer. Ability to clear an extensive criminal background check.
Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply on line. All correspondence from the Office of Human Resources will be through electronic mail.
This position is located in Program Integrity.
If you are interested and qualified to follow the job recruitment, you have to prepare yourself and send your application letter immediately. Only candidates who meet the criteria for Program Coordinator II in Richland County, Richland County who will be called to attend interview. If you still do not satisfy with our job recruitment information above, you can try to read other job recruitment information that we provide in our website which still located in Richland County region from any other company. You can also try to find other job recruitment information for Program Coordinator II in Richland County below.
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