- Make it human. We care about the people that make up our customers, colleagues, and communities.
- Make it about others. We do whats best for our customers and collaborate to drive progress.
- Make it happen. We work with intention toward a common purpose and forge ways forward together.
- Make it better. We create fulfilling purpose-driven careers by learning from the world and each other.
- You will be responsible for communicating with medical personnel at Long Term Care Facilities by conducting telephonic assessments for claimants to develop the plan of care and provide tax qualified certifications as required by the policy.
- You will be responsible for obtaining information about the medical status and care needs of the insured to best understand the disease progression, ADL/IADL loss, and cognitive status.
- You will be responsible for making decisions about the care need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and the HIPAA regulations related to Tax Qualification Certification. You will be responsible for working within a structured environment with established Standard Operating Procedures to ensure consistency of claims practices.
- You will be responsible for communication, teamwork and collaboration, and partnering with other teams or departments to achieve common goals and support continuous improvement initiatives.
- You will be responsible for identifying, requesting, and analyzing pertinent medical records required to best understand the disease progression, ADL/IADL loss and potential for recovery.
- You will identify process improvement opportunities, provide feedback on processes and case management model as well as be a critical team member in enhancing the teams performance and results. ?
- Active Registered Nurse (RN) licensure
- At least two years-experience working in a role that required an understanding of single and cumulative medical conditions (particularly those common in the aging process), including their effect on physical/cognitive function, as well as their prognosis and rehabilitative potential.
- Able to understand and interpret MDS, Plan of Care, Physician Records and Occupational/Physical Therapist records and understand disease progression and recovery expectations.
- Extraordinary internal and external customer service skills including patience, tactfulness, ability to remain calm and composed under pressure, effective listening skills, and professionalism.
- Able to manage and prioritize a work queue and multiple job responsibilities.
- You will be expected to have consistent, reliable, and predictable attendance to support the needs of the business.
- Ability to understand and Interpret Insurance Contracts and Long-Term Care Benefits.
- Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint, etc.).
- Bachelors Degree in Nursing, similar sciences, or higher postgraduate education
- At least 2 years of medical experience with older adults and their families (hospital, nursing home, or community placements).
- Experience in a Long -Term Care and/or Hospice setting
- Strong knowledge of senior/geriatric/home health care, continuum of care, long-term care insurance and/or the Medicare program.
- Geriatric medical knowledge.
- Competitive Compensation & Total Rewards Incentives
- Comprehensive Healthcare Coverage
- Multiple 401(k) Savings Plan Options
- Auto Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded)
- Generous Paid Time Off Including 12 Paid Holidays, Volunteer Time Off and Paid Family Leave
- Disability, Life, and Long Term Care Insurance
- Tuition Reimbursement, Student Loan Repayment and Training & Certification Support
- Wellness support including gym membership reimbursement and Employee Assistance Program resources (work/life support, financial & legal management)
- Caregiver and Mental Health Support Services
-
Clinical Support Specialist
3 weeks ago
HealthReach Community Health Centers Richmond, United StatesRichmond Area Health Center is seeking a **Clinical Support Specialist** to join our active and friendly family practice. The Clinical Support Specialist supports the provider and nursing teams with administrative duties such as chart preparation, running reports, completing pape ...
-
Oncology Clinical Specialist Ii
1 week ago
Henrico Doctors' Hospital Forest Richmond, United States**Introduction**: · **Benefits**: · Henrico Doctors' Hospital Forest, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: · - Comprehensive medical coverage that covers many common servi ...
-
Claims Clinical Specialist
3 weeks ago
Genworth Richmond, United StatesAt Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, an ...
-
Clinical Nurse Specialist-ft Days
1 week ago
Bon Secours Richmond, United StatesWith a legacy that spans over 150 years, Bon Secours is a network that is dedicated to providing excellent care through exceptional people. At every level, everyone on our teams have embraced the call to provide compassionate care. Here, you can work with others who share common ...
-
Clinic Compliance Specialist
1 week ago
LifeLong Medical Care Richmond, United StatesClinic Compliance Specialist · Job Locations · US-CA-Richmond · ID · Overview · Supporting Community Healthcare is a rewarding role. LifeLong Medical Care is looking for a · Clinic Compliance Specialist · at our Jenkins Health Center in Richmond, CA. The Clinic Compliance ...
-
Clinical Technology Specialist
3 days ago
ForTec Medical Richmond, United StatesJob Description · Job DescriptionCompany Description · At ForTec, we offer an independent work environment, training on the top medical technologies, and interaction with physicians and medical professionals. We provide our employees with a generous benefits package including: · ...
-
Clinical Specialist
1 week ago
Boston Scientific Richmond, United StatesAdditional Location(s): N/A · Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - High Performance · At Boston Scientific, we'll give you the opportunity to harness all that's within you by working in teams of diverse and high-performing employees, tackling ...
-
Clinical Specialist, Vessel Closure
1 week ago
Abbott Laboratories Richmond, United States Full timeAbbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medic ...
-
Clinical Specialist, Vessel Closure
1 week ago
Abbott Laboratories company Richmond, United StatesAbbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medic ...
-
Clinical Specialist, Pediatric Nutrition
1 week ago
Abbott Richmond, United StatesJob Description · Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and bra ...
-
Radiotherapy Clinical Application Specialist
3 weeks ago
Vision RT Richmond, United StatesVision RT is a rapidly expanding MedTech company at the forefront of transforming radiation therapy. We are the inventors of Surface Guided Radiation Therapy (SGRT), which harnesses advanced 3D camera systems and sophisticated AI, Computer Vision, and Machine Learning software. O ...
-
RN/Clinical Innovation Specialist
4 weeks ago
Department of Veterans Affairs Richmond, United StatesSummary · Full Position Title: RN/Clinical Innovation Specialist · Learn more about this agency · Help · Overview · * Accepting applications · * Open & closing dates · 04/16/2024 to 05/06/2024 · * Salary · $86,619 - $160,386 per year · * Pay scale & grade · VN 00 · * Help · Locat ...
-
Clinical Transformation Specialist
3 weeks ago
CVS Pharmacy, Inc. Richmond, United StatesThis position is a licensed mental health professional with clinical expertise and knowledge in the behavioral health provider space. Key duties of this position include: a. Work directly with behavioral health providers and agencies around developin Behavioral Health, Clinical, ...
-
Clinical Reimbursement Specialist
1 week ago
Laurel Health Care Company Careers RICHMOND, United States Permanent, Full timeAre you are you a Registered Nurse (RN) who is passionate about MDS? When you join Ciena Health Care Company as a Clinical Resource Specialist, you will share your expertise with the MDS nurses in several facilities. In this role, you will audit and evaluate Medicare compliance a ...
-
Clinical Referral Specialist
2 weeks ago
LifeNet Health Richmond, United Statesclinical Referral Specialist · Location: Richmond, VA · Department: Clinical Services · Clinical Classification: Clinical Plus · Job Type: Full-Time · Shift: 12-hour shifts; 13 shifts per month; 2 weekends per month & some holidays · LifeNet Health is searching for talented indiv ...
-
Clinical Nurse Specialist-FT Days
2 weeks ago
Bon Secours Richmond, VA, United StatesThank you for considering a career at Bon Secours · Job Description · Primary Function/General Purpose of Position · The Advanced Practice Nurse (APN) at St. Mary's Hospital is a professional nurse prepared at a Masters level in nursing with expertise in a specific area of clinic ...
-
Clinic Compliance Specialist
3 weeks ago
LifeLong Medical Care Richmond, United States· Clinic Compliance Specialist · Job Locations · US-CA-Richmond · ID · Overview · Supporting Community Healthcare is a rewarding role. LifeLong Medical Care is looking for a Clinic Compliance Specialist at our Jenkins Health Center in Richmond, CA. The Clinic Compliance Speciali ...
-
Clinic Compliance Specialist
2 weeks ago
LifeLong Medical Care Richmond, United StatesOverview: · Supporting Community Healthcare is a rewarding role. LifeLong Medical Care is looking for a Clinic Compliance Specialist at our Jenkins Health Center in Richmond, CA. The Clinic Compliance Specialist together with the Center Director, oversees compliance, lab, and im ...
-
Clinical Support Specialist
3 weeks ago
Northern VA Community College Richmond, United StatesPosting DetailsPosting Summary Working Title Clinical Support Specialist (Nursing) Role Title Education Support Spec III Role Code 29144-FP FLSA Nonexempt Pay Band 04 Position Number 280W1001 Agency Northern VA Community College Division NV280-Provost Medical Educ Ctr Work Locati ...
-
Clinical Support Specialist
3 weeks ago
Northern VA Community College Richmond, United StatesPosting Details · Posting Summary · Working Title · Clinical Support Specialist (Nursing) · Role Title · Education Support Spec III · Role Code · 29144-FP · FLSA · Nonexempt · Pay Band · 04 · Position Number · 280W1001 · Agency · Northern VA Community College · Division · NV280 ...
Claims Clinical Specialist - Richmond, United States - Genworth
Description
At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, and neighbors of those that need careand we bring those experiences with us to work in serving our millions of policyholders each day.
We apply that same compassion and empathy as we work with each other and our local communities, Genworth values all perspectives, characteristics, and experiences so that employees can bring their full, authentic selves to work to help each other and our company succeed. We celebrate our diversity and understand that being intentional about inclusion is the only way to create a sense of belonging for all associates. We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism.
Our four values guide our strategy, our decisions, and our interactions:
POSITION TITLE
Claims Clinical Specialist Medical Review Team
POSITION LOCATION
This position is available to Virginia residents as Richmond or Lynchburg, VA Hybrid in-office applicants or remote applicants residing in states/locations under Eastern or Central Standard Time: Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington DC, Vermont, West Virginia or Wisconsin.
YOUR ROLE
As an Operations team member, you will play a crucial role in delivering world class customer service and capabilities to our policyholders now and in the future.
The Claims Clinical Specialist role is an excellent opportunity for a Registered Nurse seeking a career change. Bring your nursing knowledge and experience, and Genworth will provide the training necessary to succeed as a Medical Review Nurse. You will be responsible for improving our in-house certification functions by providing updates to the plan of care, in-house certifications, completing assessments, and monitoring low-risk claimants. This position will promote the provision of evidence-based, short-term case management services to long-term care insurance policyholders.
What you will be doing
What you bring
Nice to Have
Employee Benefits & Well-Being
Genworth employees make a difference in peoples lives every day. Were committed to making a difference in our employees lives.
ADDITIONAL
The base salary pay range for this role starts at a minimum rate of $ 65,600 up to the maximum of $121,300. In addition to your base salary, you will also be eligible to participate in an incentive plan. The incentive plan is based on performance and the target earning opportunity is 7% of your base compensation. The final determination on base pay for this position will be based on multiple factors at the time of this job posting including but not limited to geographic location, experience, and qualifications to ensure pay equity within the organization.