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

Scope of Role & Responsibilities:
Complete missing information from documentation received
Confirm conflicting information accuracy in the documentation
Schedule appointments for Care management staff
Handles both incoming and outgoing calls on the MLTCP ACD
Maintain files on members and tracks status of membership
Liaison between MetroPlus and HHA/PCA/PCS/CDPAPA vendors re: communication about service to members
Assist members in scheduling necessary medical visits.
Enter prior approvals into Application System.
Use Application system to enter authorization or services as per benefit of the program.
Notifies vendors of the start date of the services to member.
Tracks and monitors key information identified by the Supervisor/Manager of MLTCP for quality purposes.
Track and monitor members admission to hospitals, nurse home facilities, ER visits and unexpected outcomes
Track and process faxes within application systems
Track members short-term absence from geographic areas.
Notifies Care Manager if a member cannot be contacted.
All other tasks assigned by the Team Lead or the management team.

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

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

Languages:
English

Schedule Notes:
Work Schedule: Full time
Hours Per Week: 35
Days: Monday, Tuesday, Wednesday, Thursday, Friday
Shift time: 9am - 5pm
Work location: Hybrid
Patient Facing: No
Minimum education level: High school
Language competencies: English
License/Registration required: No