Care Management Associate (000087)

Job Description

Job Description

A healthcare organization is seeking a Care Management Associate to support member case intake, care coordination, enrollment activities, and service authorization workflows. This hybrid, non-patient-facing position works closely with care management staff, members, healthcare providers, and vendors to help ensure accurate and timely coordination of services for managed long-term care members.

Responsibilities:

• Handle incoming and outgoing calls related to member care and service coordination.

• Schedule appointments for Care Management staff and assist members with scheduling necessary medical visits.

• Maintain member files and track membership and case status.

• Serve as a liaison between internal teams and home health/personal care vendors regarding member services.

• Enter prior approvals and service authorizations into CareConnect based on program benefits.

• Monitor authorization queues to support timely processing of service requests.

• Notify vendors regarding the start, end, or cancellation of member services.

• Track hospital admissions, nursing facility admissions, emergency room visits, and other identified member outcomes.

• Track documentation required for authorization and reauthorization of Personal Care Services, including physician orders and M11Q documentation.

• Coordinate completion of Occupational Therapy evaluations when required.

• Print and mail Home Health Aide and Personal Care Aide Plans of Care.

• Notify Care Managers when members cannot be contacted and assist with follow-up activities.

• Review documentation for missing or conflicting information and work to resolve discrepancies.

• Support MLTC/MAP enrollment, disenrollment, eligibility, and transfer processes.

• Create initial authorizations for new enrollments and maintain enrollment documentation.

• Conduct welcome calls and other telephone outreach to members, physicians, and care team members.

• Research and respond to enrollment, eligibility, transfer, and disenrollment inquiries.

• Assist with mailing and faxing documentation needed for enrollment and plan transfer activities.

• Maintain a high level of data-entry accuracy across applicable systems.

• Collaborate with internal and external teams to maintain effective workflows and operating procedures.

• Protect confidential member information and comply with applicable privacy requirements.

• Complete special projects and other duties assigned by the Team Lead, supervisor, or management.

Qualifications:

• High school diploma or successful completion of a High School Equivalency Program required.

• At least one year of satisfactory full-time work experience required.

• Three or more years of managed care or Medicaid MCO experience preferred.

• Previous customer service or call center experience preferred.

• Experience with managed care, medical management, or healthcare operations preferred.

• Understanding of medical terminology preferred.

• Knowledge of ICD-9 and CPT-4 codes preferred.

• Excellent data-entry skills and ability to maintain accuracy across multiple databases.

• Ability to multitask while maintaining a professional and customer-focused approach.

• Strong analytical skills with familiarity using spreadsheets and reports.

• Ability to work effectively in a fast-paced environment.

• Strong customer service focus, integrity, organization, and attention to detail.

Please note that the salary range and/or hourly rate range of $21.00 - $24.00 per hour is a good faith determination of potential base compensation offered to applicants at the time of this job advertisement and may be subject to modification in the future. When determining a team member's base salary and/or hourly rate, various factors may be taken into account as applicable (such as location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity).

For consideration to this and/or other roles suitable for your background, please submit your most up-to-date resume to join our talent pool.

At ATRIA Consulting, LLC, we are a woman-owned business fully committed to promoting, cultivating, and maintaining a culture of diversity, equity, and inclusion. We embrace and celebrate differences across all demographics and backgrounds. We encourage everyone to apply.