Facilitates department workflow by supporting clinical team with various care coordination workflows. Locates community services and other referral locations for enrollees, arranges access to care, supports communication with hospitals, and providers.
Provides non-clinical support to workflows involving utilization management, case management, disease management, and health promotion.
Troubleshoots when an appropriate provider, type of service, or appropriate level of care cannot be readily found.
Has current knowledge or researches availability of community resources and services and link members to appropriate services. May assist in transitions in care for hospitalized patients and makes appropriate placements, if needed.
Assumes responsibility for self-development and career progression.
Proactively seeks and participates in ongoing training (formal and informal) in all aspects of the Care Worker role.
Assists in the mentoring and training of new Care Workers.
Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
Coordinates and manages distribution of correspondence and materials to enrollees and providers.
Participates in operational activities, including data collection, tracking, and analysis.
General Job Information
Clinical Services Group
United States of America
United States of America (Non-Exempt)
Recruiting Start Date
Date Requisition Created
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
Understanding of plan benefit structures, psychiatric/medical terminology, and local communication resources.
For roles supporting the Chronic Pain Management SBU, understanding of Chronic Pain Management guidelines and workflows is also required.
Experience in a managed care environment, integrated medical and behavioral health care and/or training in chronic pain management.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.