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.
Requires a High School diploma or GED. Associates or Bachelors degree from an accredited college or university preferred.
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.
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).
Skills and Abilities
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.
The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position.