Job Details
Title: Care Management Associate - Remote
Description:
Position Summary & Duties :
Enhancement of Medical Appropriateness and Quality of Care:
Using holistic approach consults with utilization management clinicians, hospital discharge planning staff, supervisors, and/or other health programs to overcome barriers to meeting goals and objectives;
Coordinates care with providers as a part of comprehensive and proactive discharge planning.
Identifies and escalates quality of care issues through established channels.
Utilizes negotiation skills to secure appropriate options and services necessary to meet the member s benefits and/or healthcare needs.
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Proficient in key boarding, typing 45 wpm with min score of 6500 alphanumeric skill set
Process intake of services via email
Researches member eligibility information, if eligible will communicate with enrollment team to ensure member is loaded in our system correctly. Researches PCP and updates our system
Requests additional records for case managers if needed
Protects the confidentiality of member information and adheres to company policies
Computer literacy a must to be able to navigate through internal and external systems
Familiar with basic medical terminology and concepts of care management
Effective communication, telephonic and organizational skills
Must possess strong customer service skills to coordinate services
Verifyable High School Diploma or GED Required .
Experience
1 - 2 years experience as a medical assistant, office assistant, call center experience
Strong customer service skills
Strong problem-solving and analytical skills
Possess strong computer navigation skills
Comfortable with regular feedback and development
Works well in a team environment
Must have basic medical terminology experience
Education
High school diploma or GED required, 2+ years of relevant work experience in call center.
Note :
Monday to Friday 800am to 500pm .
Remote with future possibility of onsite.
Safety Sensitive
Onsite training and remote after training
This position will be dealing with very sensitive and confidential information.