Job Vacancies at Reliance HMO

Description

The Case Management & Care Coordination Associate is responsible for analyzing and reporting fraud, waste, and abuse data, managing the escalation of emergency cases, conducting mortality investigations, overseeing general case management and care coordination activities, managing at-risk cases, and monitoring ICU admissions of enrollees receiving healthcare services from providers within the Reliance HMO Providers network.

Responsibilities

• Analyze claims data, billing records, and other relevant information to identify patterns, anomalies, and potential cases of fraud, waste, and abuse
• Utilize data analytics tools and techniques to identify trends, outliers, and potentially fraudulent activities
• Manage the escalation of emergency cases, ensuring timely and appropriate interventions for enrollees in critical or life-threatening situations
• Collaborate with healthcare providers, emergency services, and internal teams to coordinate and facilitate emergency care and support
• Conduct investigations into cases involving the mortality of enrollees to determine the cause, identify potential gaps in care, and assess the quality of care provided
• Collaborate with medical professionals, forensic experts, and internal teams to gather relevant information and conduct thorough investigations
• Monitor ICU admissions of enrollees, ensuring appropriate utilization and timely interventions, assessing the necessity and appropriateness of continued stay in the ICU
• Maintain accurate documentation of emergency cases, including communication, actions taken, and outcome
• Ensure compliance with applicable laws, regulations, and company policies related to fraud, waste, and abuse investigations, emergency case management, mortality investigations, general case management, managing at-risk cases, and ICU admissions

Requirements

• Bachelor’s degree in medicine, nursing, or related disciplines
• Knowledge of healthcare operations, fraud prevention, and regulatory compliance.
• Experience in conducting fraud, waste, and abuse investigations is preferred.
• Knowledge of emergency management protocols and procedures.
• Familiarity with mortality review processes and quality improvement initiatives.
• Knowledge of legal and regulatory requirements related to fraud, waste, and abuse investigations, emergency care, and case management.
• Professional certifications in fraud examination, case management, or related fields (e.g., Certified Fraud Examiner, Certified Case Manager) are advantageous.

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Description

As a Pharmacy Assistant, you will play a crucial role in ensuring smooth operations in various aspects, including patient, vendor, and provider management. Your role encompasses a wide range of tasks, from customer service to administrative duties, logistics coordination, and compliance adherence to ensure the pharmacy operations run smoothly and efficiently.

Your job responsibilities are as follows:   

• Customer Service: Providing friendly and attentive customer service is paramount. Handle telephone inquiries and prescription pick-up/drop-off services, answer inquiries, and direct them to appropriate products or personnel.   
• Prescription Management: While you will not dispense medications, you will be responsible for assisting in managing prescription orders. This involves data entry tasks such as entering patient information and prescriptions into the computer system accurately, updating the statuses of prescriptions, and other relevant tasks.  
• Inventory Management: You will aid in maintaining adequate stock levels of medications and other pharmaceutical products. This includes monitoring inventory, restocking shelves, and alerting the pharmacist and pharmacy technician when stock levels are low.  
• Administrative Support: You will provide administrative support to the pharmacy team, which may include filing paperwork, organizing records, and managing incoming and outgoing correspondence.  
• Vendor/Provider management: Coordinating with suppliers and service providers is crucial for efficient pharmacy operations. You will manage relationships with vendors, place orders, track deliveries, and resolve any issues that may arise.  
• Team Collaboration: You will work closely with pharmacists, pharmacy technicians, and other pharmacy staff to ensure smooth operations and provide excellent customer service

Requirements

• HND/BSc degree required; additional education or certification in pharmacy technology or administration is advantageous. 
• Proficiency in the use of Microsoft Office tools and basic computer applications 
• Willingness to work on weekends 
• Excellent communication and interpersonal skills, with a customer-centric approach. 
• Strong organizational skills and attention to detail. 
• Ability to work efficiently in a fast-paced environment and handle multiple tasks simultaneously. 
• Commitment to upholding ethical standards and confidentiality in handling sensitive information. 
• Willingness to undergo training and continuing education to stay updated o