Role Description
This position is accountable for assisting and extending support to the field based Care Managers and RN I. This position also ensures facilitation of health care services within a member centric plan of care, under the direction and supervision of an RN.
• Will ensure timely appointments and scheduling.
• Assist with implementation and facilitation of services members.
• Ensure timely member follow up. Interacts and communicates effectively with the member during telephonic contact.
• Encourages member participation and compliance in the program.
• Assist with all calls to members. Coordinates the delivery of high quality, cost-effective care based on the members' needs and the managed long term support and services model supported by clinical practice guidelines established by the plan.
• Run reports to monitor compliance on scheduled services to ensure timely delivery of services and required follow up.
• Utilizes care management process for goal directed member care.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• Provides telephonic assistance for activities specific to the program.
Qualifications
• High School Diploma/GED required.
• Prefers healthcare industry experience.
• Requires a minimum of one (1) year experience in home care, discharge planning, or case management, preferably with the elderly frail population.
• Prefer a minimum of one (1) year experience in the managed care industry.
Requirements
• Requires knowledge of the standards of practice for coordination of services, and delivery of services.
• Requires strong knowledge of managed care principles and concepts including Health Plan Effectiveness Data and Information Sheet (HEDIS).
• Requires strong organizational skills.
• Requires strong oral and written communication skills.
• Requires good PC skills, knowledge of working with a Medical Management system for electronic medical records and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.).
• Requires good problem solving and conflict resolution skills.
• Requires good presentation skills.
• Requires ability to work with limited daily supervision.
Benefits
• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement
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