Healthcare Consultant III - Care Management Associate

Job Responsibilities:

• Experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavior Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.
• 2-4 years’ experience as a medical assistant, office assistant.
• Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
• Effective communication, telephone, and organization skills.
• Familiarity with basic medical terminology and concepts used in care management.
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Skills:

• Identifies principal reason for admission, facility, and member product to correctly apply intervention assessment tools. Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan. Monitors non-targeted cases for entry of appropriate discharge date and disposition. Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff. Identifies triggers for referral into Case Management, Disease Management, Mixed Services, and other Specialty Programs.
• Identifies principal reason for admission, facility, and member product to correctly apply intervention assessment tools.
• Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.
• Monitors non-targeted cases for entry of appropriate discharge date and disposition.
• Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff.
• Identifies triggers for referral into Case Management, Disease Management, Mixed Services, and other Specialty Programs.

Education/Experience:

• High School or GED IS MUST