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 Doctor's orders or M11qs Print and mail Home Health Aide/Personal Care Aide Plan of Care
Track member's 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.
The Care Management Associate, under the direction of the CMA Supervisor, is responsible for providing coordinator support to members in the MLTC and MAP lines of business. Daily activities include conducting receiving calls as part of the in-bound member call center, managing in-bound requests received by fax, and performing other duties associated with the coordination of member care in collaboration with other staff on the MLTC/MAP Team.


Scope of Role & Responsibilities:
Completes missing information from documentation received.
Confirms conflicting information accuracy in the documentation
Handles incoming calls on the MLTC and MAP ACD phone line and places onbound calls as necessary.
Maintains files on members and tracks status of membership.
Serves as liaison between MetroPlusHealth and HHA/PCS/CDPAS vendors regarding member benefits.
Enters prior approvals into systems.
Uses system to enter authorization or services as per benefit of the program.
Notifies vendors of the start date of the services for members.
Tracks and monitors key information identified by the team lead of MLTC for quality purposes.
Tracks and monitors members admissions to hospitals, nursing home facilities, ER visits and unexpected outcomes
Tracks members short-term absence from geographic areas.
Reports common trends identified during member contact
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
One year of satisfactory full-time experience in direct consumer contact.
Experience working with Consumer Directed Personal Assistance Program (CDPAP) operations, processes, and related data.
Strong analytical skills with the ability to interpret data, identify trends, and support business decision-making.
Advanced proficiency in Microsoft Excel, including the use of Pivot Tables, VLOOKUP/XLOOKUP, data analysis, reporting, and spreadsheet management.
Understanding of Medical terminology preferred.
Knowledge of ICD-10 and CPT-4 codes preferred.
Prior managed care experience preferred.
Prior experience customer services/call center experience required.

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

Languages:
English: Read, Write, Speak