Care Management Associate

Schedule:

• Schedule will be set; shifts will be based off a Central time schedule. The phone queue is open from 7am-6pm Central Time.

• Ideally, looking for someone to fill the 930am-6pm Central timeslot.

Position Summary

• The Care Management Associate (CMA) supports comprehensive coordination of medical services that include intake and outgoing calls for medical services.

• We work closely with both case management and utilization management teams.

• The Care Management Associate will review eligibility and benefits, open pre-certification cases, and either approve or send to nursing staff for review.

Additional responsibilities include but not limited to the following:

• Evaluates patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services by the benefit plan.

• Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director

• Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.

• Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropriate, utilizes internal tools to determine required steps to ensure proper review based on clinical requirements as well as established plan guidelines.

• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.

• Ensures communication, both internally and externally, to enhance the effectiveness of medical management services (e.g., health care providers, and health care team members respectively).

• Assist in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow up as needed.

• Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, policies, and procedures.

• Operates with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work.

Required Qualifications

• 2 years’ experience as a medical assistant, office assistant or related experience.

• Minimum of 6 months of call center experience required.

Preferred Qualifications

• Effective communication, telephonic and organization skills.

• Familiarity with basic medical terminology and concepts used in care management.

• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification, and resolution of issues to promote positive outcomes for members.

• Computer literacy to navigate through Internal/external computer systems, including Excel and Microsoft Word.

Education

• High School Diploma or equivalent GED