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Case Manager (PPOC)
| Location: | Downtown, Toronto, Ontario, Canada |
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| Job Type: | Permanent |
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| Posted: | 7th Jun 2010 |
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| Closing Date: | 5th Jul 2010 |
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| Posted By: | World Travel Protection Canada Inc. |
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| Details: | |
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Case Manager (PPOC)
Adjuvantz is a leading Canadian patient assistance organization providing reimbursement support and advocacy, compliance and retention monitoring, and a variety of other services to patients who have been prescribed medications for chronic conditions.
Responsible for service issues and daily activities associated with existing client accounts and assigned vendor contacts. This position also will provide timely and reliable reports to the client and Account Management to track current trends and identify areas where additional opportunities exist.
Job Qualifications:
Bachelors Degree or equivalent
5 or more years of related experience.
1. Knowledge of Microsoft Office Suites, ACCESS, Internet, Lotus Notes
2. Knowledge and understanding of Managed Care industry for W/C, inclusive of bill review, medical management, national/local certifications and workers' compensation rules and regulations
3. Preferable knowledge and understanding of Managed Care industry for Personal and Workers Compensation lines.
4. Knowledge of claim handling process
5. Knowledge of project management
6. Excellent organizations skills
7. Excellent interpersonal communication skills, with the ability to communicate to ALL management levels within the division as well as across Business Units, SBUs and SSUs
8. 2+ years of Account Management experience
9. Ability to manage multiple projects simultaneously
10. Excellent decision making-skills
11. Excellent oral and written communication skills with a strong customer service orientation
12. 3+ years of service industry experience
13. Excellent problem solving skills
Job Accountabilities:
1. Maintain open channels of communication with the client and service departments to resolve all managed care issues.
2. Responsible for compiling and distributing monthly and /or quarterly management reports for Business Units
3. Coordinate and track PPO nominations and status
4. Support Manager, National Accounts by providing research and recommendations in response to internal/external customer inquiries.
5. Coordinate the generation and shipment of accurate and timely customer reporting.
6. Provide managed care materials, i.e. FL MCA materials, to customers as requested.
7. Work closely with the National Accounts Manager to develop and implement new managed care programs designed to meet the needs of the customer.
8. Conduct marketing presentations to internal and external customers and represent Managed Care department, as needed.
9. Provide initial evaluation of potential or existing vendors capabilities, products and services.
Business Accountabilities:
1. Anticipate, recognize and respond to needs of customers.
2. Support implementation of customer initiatives
3. Provide status updates
4. Resolve technical problems by referring to policies, procedures, specifications
5. Compare alternatives for solving problems or improving procedures or products and provide recommendations
6. Provide technical expertise for short-term, defined scope projects.
Performance Management Accountabilities:
1. Model behaviors that demonstrate commitment to corporate values.
2. Take accountability for participating in the performance management cycle.
3. Participate fully as a team member and contribute to the improved performance of the team.
4. Expand knowledge and exchange it with team members and business partners.
5. Take action to manage own personal development. |
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