Case Management Processor

Job Title: Case Management Processor
Job Location: Must reside in Michigan (preferably near Detroit, Wayne, or Macomb County)
Job Duration: 2-3 Months (possibility of extension)
Work Arrangement: 90% Remote / 10% Field Work
Shift: Monday - Friday, 8:30 AM – 5:00 PM EST
Duration: Temp-to-hire opportunity

Job Summary:

• Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential.
• HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Duties and Responsibilities:

• 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 policies.
• Provides telephone, clerical, and data entry support for the Case Management team.
• Responsible for initial review of assigned case levels to assist in Case Management assignment.
• Reviews data to identify principal member needs and works under the direction of the Case Manager to implement care plan.
• Schedules member visits with team members as needed.
• 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.
• Processes member and provider correspondence.
• This position will be outreach members to engage and help to close out quality gaps, along with transferring calls to a phone queue where a Care Manager can assist in completing an assessment and care plan with the member.
• The case management processor will also be working in chart retrieval projects, calling provider offices, faxing, reviewing/scrubbing/renaming and uploading charts, researching provider office and member information in internal and external systems.
• Collaborating with team to meet deadlines and timelines for projects with high visibility.
• Could include onsite visits to collect medical records.

Required Education:

• HS Diploma or GED.

Required Experience:

• 1-3 years' experience in an administrative support role in healthcare.

Preferred Education:

• Associate degree.

Preferred Experience:

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred, basic knowledge of HEDIS and NCQA.

Other Requirements:

• Must have a valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Skills:

• Basic computer skills (e.g. Microsoft Office).
• Proficiency in data analysis tools (e.g. Microsoft Excel).
• Ability to manage files, schedules and information efficiently.
• Phone communication skills.
• Internet that will support Client internal systems.