Suleka Stieber

Answering incoming calls from members enrolled in Dual Specials Needs Plan - Care Management.

Make outgoing phone calls to members to complete their yearly health assessments.

Complete yearly care plans.

Educate members about their health insurance plan and making them aware of their benefits, rewards and incentives available to them. Provide them with resources that can assist with the daily needs such as housing and food. Assist members with locating healthcare providers.

Once health assessment is completed with a member assign them a Care Manager who can assist with their healthcare needs.

Notify our pharmacy department when our members have problems obtaining their necessary medications/prescriptions.

Accept incoming phone calls and directing them to the appropriate areas.

Responsibilities include:

• locking front door of the facility at the end of the night.
• taking payment for lunch tickets from staff.
• tracking patient deliveries that arrive for patient by -
• notifying a unit when a package/bag arrives and documenting who picks up the packages/bags.
• making sure all doors in lobby-area are locked before
• leaving and a complete check is done to make sure there are no problems with fire alarms or parking lot lights. Any problems encountered are immediately reported to nursing supervisor.
• making requested announcements from emergencies to paging a doctor via the hospital paging system.

Processed prior auth requests for the following types of providers:

Inpatient Rehabilitation Centers

Outpatient Physical Therapy and Occupational Therapy.

Ambulance

Chiropractors.

When necessary assisted other utilization management departments with their prior auth requests as well such as Podiatry Care and Durable Medical Equipment.

Responsible for educating healthcare providers on what documents are needed in order for prior auth requests to be processed correctly. Once clinical documents were received prior auth requests were either approved or sent to clinical staff for further review.