Care Specialist Jobs

Summary of Position:

• Responsible for the execution of the non-clinical aspects of the Care Management process.
• Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations, request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a case.
• Provide telephonic outreach to members that have been identified for care management and ensure members’ needs are supported throughout the duration of member enrollment to the program, by completing screenings with members, coordinating with Care Manager on members’ care plan, making appropriate referrals to the interdisciplinary care team, coordinating post-acute services on behalf of members, assisting with community resource needs and more.
• Provide confidential administrative support and assistance to the department and support the department in all aspects of daily project operations.
• Work seamlessly with the Care Specialists, Care Managers and Social Workers (and other clinical staff) to ensure everything that a participant needs to tend to their health is addressed.
• Assist the entire Care Management interdisciplinary team in managing members with Care Management needs.

Principal Accountabilities:

• Perform a wide range of research and educational outreach activities to encourage healthy behaviors, such as outreaching to identified members who need a primary care provider or who may have gaps in care related to recommended tests or provider visits and facilitate gap closure and receipt of evidence-based care.
• Enter and maintain documentation in electronic record, meeting defined timeframes and performance standards.
• Coordinate directly with community-based organizations and agencies to identify available and/or alternative resources for a wide range of concerns, including home safety, financial assistance, caregiver support and transition assistance.
• Actively participate in assigned committees and projects.
• Communicate and/or respond to inquiries from providers, facilities and members.
• Triage cases and assign receipts to appropriate teams.
• Perform member telephonic outreach for program enrollment with the goal of retaining members in the Care Management Program.
• Under the direction of a Care Manager, manage caseload and update care plans for low and moderate risk members in collaboration with the clinical team.
• Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities.
• Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
• Provide phone queue management for both incoming and outgoing calls.
• Additional tasks and duties as required.
• Perform other related projects and duties as assigned.
• Leverage motivational interviewing skills and a member-centric approach to identify members’ needs, prioritize, and support care plan.
• Perform accurate and timely intake and data entry for all Care Management requests and referrals for all lines of business, upon receipt of inbound requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements.
• Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
• Support care interventions including making doctor’s appointments, health coaching, referrals to internal and external resources, assist with transportation issues.
• Support communication and coordination with delegated entities, as necessary.

Education, Training, Licenses, Certifications:

• High School Diploma required.
• Associate Degree or Medical Assistant certification preferred.
• Bachelor’s in related field preferred.

Relevant Work Experience, Knowledge, Skills, and Abilities:

• Ability to work both independently and collaboratively with others. (R)
• This is a remote role, must be able to work an EST schedule.
• At least 1-2 years of previous client-facing or data entry experience in a health care environment. (R)
• Strong oral, written and interpersonal communication skills required. (R)
• Previous system user experience in a highly electronic environment required. (R)
• Knowledge of medical terminology and medical payment preferred. (P)
• Additional years of experience/certifications/training may be considered in lieu of educational requirements. (R)
• Proficiency in Microsoft Office suite skills required. (R)
• Ability to prioritize multiple tasks. (R)
• Ability to work a 90+ day assignment (R)