Case Management Processor

Job Description:

Will this role be fully remote? Yes

Are there any specific locations the candidates should be in?

We always prefer within KY because members are more likely to talk to them, but there aren t limitations on this role since it s nonclinical.

They must have adequate internet connection to support their day to day work.

What is the expected schedule (include dates/time) 8:30-5:00 EST is the typical schedule.

Sometimes members request to be called after 5:00. When that happens the CMP can flex their schedule to accommodate (work 9:30-6:00, for example) or ask another team member if they re able to make an after-5:00 call.



What are the day to day job duties?

This role will be assisting our Medicare team with STARS compliance.

The largest portion of the responsibilities will be member outreach to attempt to complete health risk assessments.

The CMP will work within our care management platform to document their call attempts according to protocol.

They will send tasks to other team members within the platform (also according to protocol).

They will work within SharePoint and excel as well.

There may be some generation of letters, which is also done within the care management platform and some general administrative support, such as looking up phone # s, entering located phone # s in excel or other platforms, etc.

All work must be completed timely or we will be out of compliance with Medicare requirements.



Top Skills Required:

Communication and people skills. Being able to engage with our members is crucial. Some proficiency with technology and use of applications is expected.

We don t want to have to train very basic excel skills (no more than basic skills are needed), for example.



Required Education/Certification(s):

High school diploma is required.

Certifications or degrees in human services, medical fields, or other applicable areas are preferred.



Required Years of Experience:

3+ years of experience working in customer service or other people-facing role is preferred.



Duties and Responsibilities (List all essential duties and responsibilities in order of importance)

Provides support to the Case Management staff performing non clinical activities and supporting the management

of the department.

Responsible for initial review and triage of Case Management tasks.

Reviews data to identify principle member needs and works under the direction of the Case Manager to implement care plan.

Screens members using Client policies and processes assisting clinical Case Management staff as they identify appropriate medical services

Coordinates required services in accordance with member benefit plan.

Promotes communication, both internally and externally to enhance effectiveness of case management services (e.g., health care providers and health care team members).

Runs reports to assist in coordination of case management needs.

Provides support services to case management team members by answering telephone calls, taking messages and researching information.

Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.

Protects the confidentiality of member information and adheres to company

Knowledge, Skills and Abilities ( List all knowledge, skills and abilities that are necessary to perform the job satisfactorily)

Strong customer service skills to coordinate service delivery including attention to members/customers, sensitivity to concerns, proactive identification and resolution of issues to promote positive outcomes for members

Demonstrated ability to communicate, problem solve, and work effectively with people

Working knowledge of medical terminology and abbreviations

Ability to think analytically and to problem solve.

Good interpersonal/team skills

Must have a high regard for confidential information

Ability to work in a fast paced environment

Able to work independently and as part of a team.

PC experience in Windows environment and accurate data entry at 40 WPM minimum.

Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

Ability to establish and maintain positive and effective work relationships with coworkers, clients, members,

providers and customers



Required Education:

High School Diploma or G.E.D.



Required Experience:

Two or more years experience as a medical assistant,

office assistant or other healthcare service administrative

support role.