Coverage Case Manager-Access to Care

Summary

A professional social services position that effectively manages and navigates the MaineCare and Health Insurance Marketplace, assisting with the application process and enrollment on behalf of uninsured and underinsured individuals.

The Coverage Case Manager (CCM) serves as a resource for clients in addressing the social determinants of health. This position will collaborate with various departments, including the Central Billing Office, to coordinate payment for care, facilitate the exchange of necessary forms and information for the client, and connect clients to other community resources as needed.

This position will also be trained as a Maine Enrollment Assistor (MEA) or Certified Application Counselor (CAC)to provide enrollment assistance in the Health Insurance Marketplace.

The CCM is responsible for screening program members for eligibility in local, state and federal programs such as MaineCare, Free Care, General Assistance, Medicare Savings Programs, etc.

and assisting with other tasks related to enrollment, reenrollment, prescription assistance, case management, and other projects as assigned to ensure members can access care as necessary.

Provides in depth research, information and connection to available community resources.

Required Minimum Knowledge, Skills, and Abilities ( KSAs )

• Education : Bachelor’s degree or 2 years relevant experience preferred.
• License / Certifications : Certification as a Maine Enrollment Assistor or Certified Application Assistor with the Health Insurance Marketplace preferred.

Current, valid driver’s license to operate a motor vehicle, with vehicle available for work preferred.

• Experience : Two years of relevant experience in social / human services, health care or related field preferred. Knowledge of state and federal agencies, community resources, experience with community outreach and networking, and strong advocacy skills preferred.
• Ability to speak and / or communicate in multiple languages preferred, as identified by the community served.
• Demonstrates a high level of analytical skills and good judgement in assessing and planning for the varying needs of clients.
• Responsible for making independent decisions of a significant nature to ensure positive outcomes for clients.
• Interpersonal skills necessary to effectively, compassionately and cordially interact with the varying audiences, including clients, foreign language interpreters, health care providers, and billing associates.
• Excellent written, verbal, and listening skills to explain policies and procedures to applicants, enrollees, providers and the general public.
• Excellent mathematical and computation skills required to prepare reports, perform calculations, and complete forms.
• Strong customer service, teamwork, resource knowledge and advocacy skills.
• Excellent organizational skills and attention to detail.
• Proficient computer knowledge of Microsoft Office Products (Word, Excel, Access, Power Point), electronic medical records and internet is necessary.
30+ days ago