Case Manager

hace 1 semana

Panama Axa Group A tiempo completo

Revisión desolicitudesde pre - autorizaciones deacuerdo conpautasmédicasinternacionalesy /oevidencia científica para evaluar lanecesidadmédicay elegibilidaddecoberturasegúnlascondiciones del Plan deBeneficiosPCABP.Produce periódicamentelosinformes deproductividady actividades solicitadospor susupervisor; Director médico asociado y/o Director de Salud (por ejemplo: informes de llamadasde seguimiento, reporte decensoy egresos)Determina siel pacientefueadmitidoadecuadamenteenloscentros deatención, se procesóla documentaciónadecuada y se prestaronlosservicios necesarios enelpuntodeadmisión.Coordina efectivamentecon el médicotratante, centrodeatencióny casemanager asignadoa los hospitalesla ocupacióny la disponibilidadpara procedimientos electivos.Revisar losregistrosmédicos delosmiembros hospitalizadosprevia solicitudy autorizacióna DirecciónMédica del centro de servicios desaludy del miembroy/osusfamiliares.Supervisar ydocumentar el progresodelos pacientes bajotratamientoenlossistemasinformáticosutilizados para tal fin.Coordina y asegura el seguimientodel plandealtaoegreso(discharge planning)para el miembro querecibetratamiento hospitalario.Monitorea la puntualidad yperiodicidaddelos exámenesde seguimientodelpacienteyreportalosresultados enlas herramientastecnológicas desoporte.Apoyar el desarrollodeprogramas de gestióndemedicina preventivaLlevarunregistro detodaslasactividadesrealizadasal documentarlasen elsistema deinformación de gestión.Revisar la necesidadmédica y la idoneidad delosserviciosdeatenciónmédica.Llevar unregistro detodaslasactividadesrealizadasal documentarlas enel sistema deinformación de gestión.Realiza seguimientomediantellamadastelefónicas, asegurandolaparticipacióny adherencia delosmiembros enlos programas degestión demedicina preventiva y de seguimientodeatención deenfermedades.Proporcionar educacióna pacientesy proveedores sobre elusoapropiadodelosrecursosmédicosy los beneficios delplan.Supervisar el cumplimientodelos proveedores médicos conlas guías, pautasyprotocolos estándares detratamiento.Analizar y discutir conlos proveedores(médicostratantes/especialistas)lasopcionesapropiadasdetratamiento cuando sea necesario.Revisa e informa diariamente losingresos hospitalariosy elabora el censo de pacientesadmitidosenloscentros hospitalarios.Informa a Director MédicoAsociadoyDirector de Salud sobre eventosadversos,eventos evitablesy eventoscentinela (never event).Contactar con proveedoresmédicos para obtener informaciónmédica adicional paralagestión de solicitudes depre
- autorizacionescuandoseanecesarioPresentacióndel casoalDirectorMédicoAsociadopara evaluaciónadicional, encasonecesario.Ejecutar lasacciones encomendadas por el Director MédicoAsociado-Director deSalud para el cumplimientodelos programas deprevencióny control de enfermedadesdiseñadospor el departamentomédico.Verificar cumplimientodeaprobación por U.S. FoodandDrugAdministration(FDA)paralosmedicamentos y dispositivos prescritosa losmiembrosdel plan, asegurandoademás cumplimientodenecesidadmédica y cumplimientodeguíasde tratamientoestandarizadas.Participar enreunionescon hospitales, representantesde AJAC y miembros deAXA, según sea requeridopor el Director MédicoAsociadoopor el Director Médico.Evaluación,discusióny orientación decasosjuntoa su supervisor inmediato.Colaborar enla organizacióny desarrollodeferias delasaludy otros eventos deeducaciónmédicapara miembrosy proveedores.Proporcionar educación en saludsobre prevenciónde enfermedades, estilosdevida saludablesyactividadesdebienestar a personalde AXAPartnersPCABP, miembrosy proveedores.Interactuar regularmenteconmédicos, personal y pacientes paraevaluar lasnecesidadesy mejorar continuamentela calidad del servicioprestadoSu PerfilTécnicas/ conocimientos funcionales,habilidadesydestrezas Gestión deherramientasdeoficina y computación.SoftwareOffice.Excelbásico
- intermedio InglésintermedioCapacidadderedaccióndecorreosy minutasLectura crítica y comprensiva deinformaciónclínica,administrativa y entrenamientosCapacidadpara trabajar en equipoy administrar eltiempodemanera efectivaProactivo, planificador, organizado, innovadorConocimientoen billingy codificación decuentasmédicas (Códigos CPT - ICD-10)Habilidadesdecomunicación y analisis.Educación, calificaciónProfesional y experiênciaEstudioscompletos enmedicinaExperiência encasemanagement(deseable)Experiência enárea administrativa decentrosde saludoindustriade seguros(deseable)Acerca de AXAEl Grupo AXA es líder mundial en seguros y gestión de activos.Protegemos y asesoramos a nuestros clientes en todas las etapas de su vida, ofreciéndoles productos y servicios que satisfacen sus necesidades en las áreas de seguros, protección personal, ahorro y gestión de activos.AXA es la primera marca de seguros del mundo, con más de 100 millones de clientes.Nos estamos transformando de pagador a socios de nuestro cliente, con un fuerte enfoque en la preve

  • Case Manager

    hace 2 semanas

    Panama AXA A tiempo completo

    Revisión de solicitudes de pre - autorizaciones de acuerdo con pautas médicas internacionales y / o evidencia científica para evaluar la necesidad médica y elegibilidad de cobertura según las condiciones del Plan de Beneficios PCABP. - Produce periódicamente los informes de productividad y actividades solicitados por su supervisor; Director médico...

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    hace 4 semanas

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    hace 4 semanas

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    hace 2 meses

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    hace 2 semanas

    Panama Philips A tiempo completo

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    hace 3 semanas

    Panama Selina A tiempo completo

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    hace 3 semanas

    Panama Hias A tiempo completo

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    hace 4 semanas

    Panama Gras Savoye A tiempo completo

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    hace 1 mes

    Panama Selina A tiempo completo

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    hace 4 semanas

    Panama Philips A tiempo completo

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    hace 7 días

    Panama STT Group A tiempo completo

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    hace 3 semanas

    Panama Philips A tiempo completo

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    hace 2 semanas

    Panama Citi A tiempo completo

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    Panama Sba Communications A tiempo completo

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    hace 2 semanas

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