Case Manager Transplant

Job Description

Job Description

Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.

POSITION SUMMARY:

The Case Manager for Transplant and Dialysis provides comprehensive support for members with specialized health benefits, including travel and care coordination at top medical facilities for serious conditions. This role anticipates and resolves member issues, facilitates next steps, addresses financial barriers and ensures access to quality care. The Case Manager also manages clinical travel operations and participates in after-hours on-call rotations.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Case Management: Manage a caseload of 95+ members, acting as the primary point of contact.
• Hospital & Transport Coordination: Arrange hospital transfers and emergency medical transport for transplants.
• Eligibility & Education: Verify member eligibility and educate them on transplant and dialysis benefits.
• Member Support: Handle high-stress calls, resolve member inquiries and provide guidance on next steps.
• Referral & Account Management: Process new referrals and proactively research member accounts.
• Documentation & Communication: Record all interactions and coordinate with various stakeholders.
• Issue Resolution: Address billing issues, claim denials and travel-related inquiries.
• Member Education: Provide clear guidance on benefit parameters to ensure high member satisfaction.
• After-Hours Support: Work independently after hours to resolve urgent issues.
• Process Improvement: Identify workflow gaps and contribute to process enhancements.
• Performance & Compliance: Meet established goals in efficiency, call quality and customer satisfaction.
• Travel Coordination: Execute travel reservations and manage travel-related expenses.
• Leadership & Support: Cover for the supervisor when unavailable and act as a resource for team members.
• Training & Development: Assist in developing training materials and onboarding new staff.
• Scheduling & Coverage: Manage on-call schedules, queue coverage and caseload/referral assignments.
• Communication Management: Monitor and respond to emails in a timely manner.
• Policy & Compliance: Review forms, policies, SPD language, scripts and job aids for accuracy.
• Reporting: Maintain and analyze reports as needed.

GENERAL EXPECTATIONS:

• Present a positive image of Consociate Health at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer or co-worker.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others.
• Attend required in-service and staff meetings.
• Seek other educational opportunities directly related to this position.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.
• Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries.

BENEFITS:

• Paid time off
• Paid Holidays
• Medical, Dental and Vision Insurance
• Basic Group Life, Short Term and Long Term Disability
• Voluntary Life, Critical Illness and Accident Coverage
• 401K Plan: Employees are immediately eligible with a 2% automatic enrollment. Consociate matches up to 4% of an employees' annual salary.

SERVICE EXPECTATIONS:

• Greet all people in a prompt and courteous manner. Communicate in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
• Ask customers what they need and strive to exceed their expectations. Offer and provide assistance whether or not the request falls within your specific job duties.
• Respond to customer requests in a timely manner consistent with Consociate Health's standards and best practices, return calls promptly and keep them informed of delays before they ask.
• Make decisions based on customer needs, opinions, complaints or suggestions.
• Take appropriate steps to resolve problems to the customer's satisfaction.
• Ask customers for their opinions, accepting criticism as an opportunity to improve service.
• Seek opportunities, provide value-added services, and eliminate tasks that do not serve our customer.
• Remain aware of products and services provided by Consociate Health.
• Project a positive, professional image when working.

KNOWLEDGE, SKILLS AND ABILITY REQUIREMENTS:

• High school diploma, GED, or equivalent.
• 1-3 years of experience in customer service, travel, healthcare or a related field.
• Ability to work independently and manage information flow.
• Ability to telecommute or reside in Central Arkansas.
• Proficiency in Office 365, Adobe and Excel.
• Must be certified and maintain Medical Travel Professional certification
• College degree in healthcare, psychology, social work or a related field preferred.
• 5+ years of experience in customer service, travel, healthcare or a related field.
• Knowledge of medical terminology.
• Experience working with transplant patients.
• Ability to perform in high-stress, time-sensitive environments.