Job Description :
The job plays a critical role in the clinical team, acting as the primary support for the clinical staff and as a liaison between all members of the care team. Works in tandem with the case managers and disease managers to help facilitate execution of case and disease management, including not limited to, tracking necessary information for member’s case, interacting with the member’s provider, enabling nurses to optimize workload, helping to arrange required services for the member, assisting with documentation. This job will collaborate and require frequent communication with other members of the team.
- Screen care management cases (condition management, disease management, etc.) to ensure information is complete and accurate (e.g. identify phone number if missing) and help prioritize cases for outreach; will triage cases to the appropriate person.
- Interact with providers to monitor members discharge status disposition, to confirm member activity, to set up appointments, and other provider related activities. Provide assistance to the case manager in monitoring member outcomes as a result of engagement in care management.
- Identify and effectively utilize health plan benefits and local provider / community resources to help meet the needs of members; develop expertise about available community resources in assigned geography and share knowledge across the team.
- Assist in report production, data collection and data entry for care plan management; perform process auditing activities to ensure compliance with NCQA standards and other compliance measures.
- Research information about members such as clinical history, utilization patterns, benefits, etc., and present information to the case manager and other care team members; help with documentation of member interventions.
- Arrange required services for the member; perform other condition and case management support activities as assigned, including member telephonic contact as appropriate per business unit needs.
- Act as the liaison among all the members of the care team and promote collaborative teamwork.
- Other duties as assigned or requested.
- High School Diploma/GED-
- Substitutions (Acceptable substitutions in lieu of a degree 1 ½ years’ experience = 1 year college)
- 3- 5 years’ performing administrative support functions in an office or field setting for a healthcare organization
- Experience utilizing customer service related skills
- Experience in a health care related customer service or marketing environment that would demonstrate the ability to positively impact the engagement of members in the Organization’s condition and case management program
- Basic knowledge of care management processes
KNOWLEDGE, SKILLS & ABILITIES (List the attributes required to perform the job through demonstrated service, education or training)
- Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, designing forms and other office procedures
- Ability to take direction, to navigate through multiple systems simultaneously
- Ability to communicate, interact, and work effectively and cooperatively with all levels of staff and management teams
- Ability to handle many tasks simultaneously and respond to customers and their issues promptly
- Ability to communicate well in person, via phone and via e-mail (verbally and written)
- Proficient computer skills, including MS Office products
TRAVEL REQUIREMENT: 0 – 25%
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