Care Management Associate (000087)

Duties:
The Care Management Associate, under the direction of the CMA Supervisor, is responsible for the daily activities of the member case intake functions and associated work flow, as well as for performing other duties associated with the coordination of member care as outlined for the MLTC/PCS Team. Handles both incoming and outgoing calls on the MLTC/PCS ACD Schedule appointments for Care management staff Maintain files on members and tracks status of membership Liaison between MetroPlus and HHA/PCA vendors re: communication about service to members Assist members in scheduling necessary medical visits. Enter prior approvals in the authorization System (CareConnect). Use CareConnect system to enter authorization or services as per benefit of the program. Notifies vendors of the start date of the services to member. Notifies vendors of end of or cancellation of services for member. Monitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requests Tracks and monitors key information identified by the Team Lead for quality purposes. Track and monitor members admission to hospitals, nursing home facilities, ER visits and unexpected outcomes Track and monitor members documentation required for authorization and re-authorization of Personal Care Services. This includes coordinating the completion of Doctors orders or M11qs Print and mail Home Health Aide/Personal Care Aide Plan of Care Track members short-term absence from geographic areas. Coordinate the completion of Occupational Therapy Evaluations Notifies Care Manager if a member cannot be contacted. Complete missing information from documentation received Confirm conflicting information accuracy in the documentation All other tasks assigned by the Team Lead or the management team. This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position, however, as a supplier your expected pay range may vary and/or include certain benefits like: Medical, Dental, Vision, 401K [include any compulsory benefits such as commissions, incentive bonuses, etc. if applicable]. Pay range: $16.48 hrly -$20.61 hrly The Care Management Associate, under the direction of the CMA Supervisor, is responsible for the daily activities of the member case intake functions and associated work flow, as well as for performing other duties associated with the coordination of member care as outlined for the MLTC/PCS Team. Handles both incoming and outgoing calls on the MLTC/PCS ACD Schedule appointments for Care management staff Maintain files on members and tracks status of membership Liaison between MetroPlus and HHA/PCA vendors re: communication about service to members Assist members in scheduling necessary medical visits. Enter prior approvals in the authorization System (CareConnect). Use CareConnect system to enter authorization or services as per benefit of the program. Notifies vendors of the start date of the services to member. Notifies vendors of end of or cancellation of services for member. Monitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requests Tracks and monitors key information identified by the Team Lead for quality purposes. Track and monitor members admission to hospitals, nursing home facilities, ER visits and unexpected outcomes Track and monitor members documentation required for authorization and re-authorization of Personal Care Services. This includes coordinating the completion of Doctors orders or M11qs Print and mail Home Health Aide/Personal Care Aide Plan of Care Track members short-term absence from geographic areas. Coordinate the completion of Occupational Therapy Evaluations Notifies Care Manager if a member cannot be contacted. Complete missing information from documentation received Confirm conflicting information accuracy in the documentation All other tasks assigned by the Team Lead or the management team. This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position, however, as a supplier your expected pay range may vary and/or include certain benefits like: Medical, Dental, Vision, 401K [include any compulsory benefits such as commissions, incentive bonuses, etc. if applicable].
The Enrollment Specialist is responsible for processing new enrollment authotizations, tracking all enrollment documents for new members. The incumbent conducts tracking of transfer requests for MLTC/MAP and works collaboratively with the Assessment Team, Enrollment and Membership (E&M) and Marketing to coordinate enrollment, disenrollment and transfers for members enrolling in MLTC/MAP.

Collaborates with the internal and external teams to develop and maintain the MLTC/MAP enrollment operational processes and procedures.
Coordinates the MLTC/MAP enrollment and disenrollment workflow.
Troubleshoots cases which require further investigation by Marketing or Maximus to complete the eligibility and enrollment process
Provides feedback regarding eligibility or enrollment inquiries to Marketing.
Creates initial authorizations for all new enrollments.
Manages all onboarding documentation for CDPAP new enrollments.
Conducts welcome call for all new enrollments.
Maintains 95% or better of accurate data entry rate in the appropriate systems.
Researches and responds to MLTC/MAP transfer/disenrollment inquiries, determines the appropriate follow up action, facilitates issue resolution and gathers supportive documentation.
Conducts telephonic outreach to program members, primary care physicians and other members of the team regarding plan transfers and disenrollments.
Conducts mailing and faxing to assist members/family with processing of enrollment and plan transfers procedures to ensure eligibility in the program.
Coordinates enrollment/disenrollment/eligibility/transfer activities and processes.

Skills:
One year of satisfactory full time experience. Understanding of Medical terminology preferred. Knowledge of ICD-9 and CPT-4 codes preferred. Prior managed care experience preferred. Prior experience customer services/call center experience preferred. Integrity and Trust Customer Service Focus Functional/Technical skills Written/Oral Communications

Required Education, Training & Professional Experience:
Excellent data entry skills in a variety of databases and telephone skills.
Must be able to multitask.
Analytical skills required; familiarity with spreadsheets and reporting.
Experience with coordinating data entry with professional, pleasant phone manner simultaneously.
Computer literacy and excellent written and oral communication skills required.
Ability to work in a fast-paced environment

Preferred Qualifications:
At least 3 years of managed care or Medicaid MCO experience.
Understanding of medical terminology.
Knowledge of medical management functions, experienced working in Medical Management.
Prior experience.

Education:
High School graduation or evidence of having satisfactory passed a High School Equivalency Program
High School graduation or evidence of having satisfactorily passed a High School Equivalency Program

Languages:
English Read Write Speak