OrthoCare Manager OrthoNet
The OrthoCare Manager is directly responsible for the overall direction, utilization, supervision, instruction, and examination of the medical care of the member patients assigned to them.
ESSENTIAL DUTIES AND RESPONSIBILITIES INCLUDE THE FOLLOWING:
1. Review of orthopedic care evaluations and progress reports to determine appropriate authorization
2. Review documentation submitted for surgical authorizations and durable medical goods.
3. Follow a patient through their entire episode of care
4. Refer cases for peer review that do not meet clinical review criteria for either initial or continued authorization.
5. Monitoring of network therapists to ensure the highest quality of Physical/Occupational/Speech Therapy and/or Orthopedic care services are being provided to the members under their care.
6. Interacting with the patient, treating therapist, and the physician to ensure the most and highest quality of care.
7. Preparation and filing of reports, outcome data, and records needed by OrthoNet.
8. Supervise Contract Assistants
9. Discharge planning prior to hospital admission and mid-transition of facilities.
10. Responsible for conducting ongoing availability, monitoring and oversight of non-clinical staff activities.
11. Perform all other duties as assigned
EDUCATION AND/OR EXPERIENCE:
A Masters and/or Bachelors Degree from an approved school of allied health or in Healthcare Administration, Nursing, Public Health or Business Administration.
Knowledge, Skills & Abilities:
State Licensed/Registered or Certified in Physical Therapy, Occupational Therapy, Speech Therapy or Nursing.
A minimum of three (3) years experience, at east one (1) year of which must have been Musculoskeletal, Discharge planning or Case Management related. (Examples of acceptable professional backgrounds are physical therapy, nursing, occupational therapy, speech therapy, athletic training, and orthopedic medicine.)
Knowledge of the principles and practice of Physical Therapy, Speech Therapy, Occupational Therapy and Orthopedic Medicine.
Knowledgeable in federal and state, HMO, NCQA and URAC compliance standards and guidelines.
Project management, interpersonal and communication skills
Balance in managing resources/ projects, leadership.
Proficiency in operating computers applications.
Excellent interpersonal skills.
Excellent verbal and written communications skills.
MACHINES, OFFICE EQUIPMENT & SOFTWARE:
MS Office (MS Word, Excel, and Power Point)
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