The purpose of this position is to ensure that the utilization process is thorough, organized and streamlined to provide the best possible length of stays for our patients. Given the complex nature of insurance these days, it is crucial to have timely communication with these payors so that families can focus on what’s important, getting their loved ones the care they need.
The ECM Clinical Manager is responsible for Clinical Oversight and Management of ECM Lead Care Managers to address the client's medical and behavioral health needs and social determinants of health, communicating wth ECM Lead Care Managers and occasionally with patients to discuss medication management. They will guide any crises encountered by ECM Lead Care Managers, collaborate with the client’s broader care team, provide client advocacy, ensure that the clients receive needed services.
Reporting to Experian Health, the EDI Analyst II will manage and support the electronic exchange of healthcare information. Responsibilities include establishing connectivity to exchange transactions, monitoring and troubleshooting EDI transactions, ensuring compliance with HIPAA regulations, and collaborating with internal teams and external partners.