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Account Navigator (RN OR LPN)

Curana Health • Full-time • Detroit, MI, USA • 1d ago

Job Details

Job Location: Detroit, MI - Detroit, MI

Position Type: Full Time

Salary Range: Undisclosed

Description

Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than 1,500 senior living community partners across 33 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the healthcare system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

Essential Duties and Responsibilities

Assist Care Ally/APP/Facilities with various system access
Claims reviews
Triage and assist with website inquiries
Assist with PQI/Grievances
Assist vendors/facilities/etc with authorization questions
Assist vendors/facilities/etc with claims questions
Assist with tracking down PCP agreements
Assist with reaching out to providers to bring them in network
Assist vendors/facilities/etc with how to bill us
Assist vendors/facilities/etc with portal issues
Portal Training
System Issues
Annual benefit document review, marketing reviews for errors
Gathering stats and agenda items for partner meetings
Network support, tracking, and managing issues (credentialing, provider updates, rosters)
Miscellaneous disenrollment issues
Visiting partners to assist with engagement
Assist sales with Lunch and Learns
Assist vendors/facilities/etc with ASC letters they receive, escalate if needed, help resolve the issue
Inbound calls from vendors/facilities/members/families for ad-hoc issues (including but not limited to OTC, how to look up a provider/medication/if a service is covered, etc)
Inbound emails from vendors/facilities/members/families for ad-hoc issues (including but not limited to OTC, how to look up a provider/medication/if a service is covered, etc)
Assist sales with broker education/ad-hoc needs
Assist with creating processes for current and future needs (CRM, disenrollment, how to order items, etc)
Assist plan management team with ad hoc requests
Coordinate meetings with current partners and plan management
Other duties as assigned

Requirements:

Experience in healthcare, skilled nursing facility
Associate or Bachelor’s Degree in healthcare or nursing
RN or LPN
Experience with claims reviews
Strong experience with Microsoft PowerPoint and Excel

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.

Qualifications

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