Health Underwriting Director jobs in Rhode Island

Working collaboratively with providers and other health care staff, providing comprehensive patient care. Responsible for the maintenance and promotion of patient health across the life cycle. Works collaboratively with other health/social agencies to provide continuity of care. Provides administrative support to the HCD.

QUALIFICATIONS  

To perform this job successfully, an individual must be able to perform each essential duty   satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE 

1. BSN from an accredited school of nursing or college preferred.  Current RN Rhode Island License is Preferred and NOT required 
2. 3-5 years nursing experience in hospital, public health or community health preferred.  
3. Ability to perform duties and responsibilities across life cycle (infants, children, adolescents, adults, prenatal and geriatric) required
4. Bicultural (Spanish) skills and Bilingual experiences strongly valued.
5. Experience in providing managed care patient services. Commitment to work in community health with the challenges of a high risk, and often uninsured and diverse patient population required.
6. Computer literacy very helpful.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Nursing Services

1. Assesses the immediate and long-term physical, mental and social health care needs of individuals and families.
2. Incorporates age appropriate principles and consider the cultural and linguistic needs of patients and families to develop a plan of nursing care.
3. Working with the individual and/or family to arrange follow-up care and provide patient education.
4. Provide support to individuals and families during periods of wellness and injury, incorporating as appropriate the medical plan of care.   
5. Initiate action by direct contact, by telephone, or referral, according to approved guidelines.
6. Managed Care
   1. Coordinate referrals by obtaining any required authorization from Health Insurance Companies.  Book appointments if required and inform patients as necessary. Follow up with results and DNKAs.  Maintain logs as required (Pap, Mammogram and ultrasound logs).
   2. Work with Staff to coordinate and track referrals and improve process.

7.  Coordinated Care/Patient Centered Medical Care Management:  

8. Works with all members of the Health Care Team towards achieving coordinated patient centered care.  Demonstrates knowledge of the goals and objectives of PCHC’s patient care management plan.  Effectively able to perform and communicate individual task within role in the process.

PCHC is EOE/M/F/D/V/SO