CARE MANAGEMENT ASSISTANT

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Position Summary

Position Summary :

The Care Management Assistant is responsible for providing non-clinical support to the Care Management (CM) Team. This role supports the operation of the Care Management team through internal and external customer service, eligibility verification, assessment and evaluation of member needs, and helps facilitate interaction with resources appropriate for the care and well-being of members.

The Care Management Assistant will also perform operational, regulatory, administrative, and customer support activities to ensure day-to-day operational functions of the care management team are met in a timely and accurate manner in compliance with contractual standards set forth by CMS, Tricare, and NCQA.

Job Description

Key Outcomes :

• Complies with all contract requirements and organizational / departmental standards regarding referrals, assessments, and provider / member communications.
• Monitors CM dashboards and assists in managing referrals to CM. Accesses Athena at least twice per day for new medallion care management referrals, triaging information, adding referrals in TruCare, and confirming referrals in Athena.

Ensures referrals are entered and processed within CMS and NCQA timeframes.

• Performs data entry into the electronic care management system and assists with tracking and trending data as needed.
• Researches provider locations including mailing and physical addresses as needed. Processes continuity of care member requests and refers to care management as appropriate.
• Performs initial outreach to introduce care management to members as appropriate.
• Performs research assistance and tracking for clinicians such as provider searches, obtaining clinical information, admission / discharge information, or clinical / health plan information that may be needed for care management including outbound calls to providers and may serve as the point of contact for external parties and the CM team.
• Responds to a variety of communications from supporting health plan departments regarding care management.
• Checks the CM resource line 2-3 times per day including returning voicemails, triaging as appropriate, educating members calling about clinically nuanced benefits, and referring members to nurse and social workers for CM follow-up.

Contacts members to conduct CM satisfaction survey calls and those that may benefit from care management or supplemental benefits, educating them on CM benefits.

• Assists members in completing their Health Risk Assessments (HRA) via phone.
• Uploads clinical information and HRA information to the electronic care management system.
• Assists clinicians with prepping for monthly interdisciplinary care team meetings for C-SNP plan. May coordinate scheduling with members and providers.
• Orders and tracks care educational materials and supplies including Krames books, internal Martin's Point educational materials, BP cuffs, scales, etc.
• Creates member educational packets.
• Assists with mailing of HRA incentives, member notifications, PHI forms, and CM educational materials and supplies under direction of clinicians.
• Sorts and reviews mail for CM team, sending returned PHI forms to Member Services. May also manage mail for Health Management Department as needed.
• Assists with newborn enrollments for USFHP.
• Orders and tracks incentives for CM programs.
• May coordinate resources for members under the direction of the clinical team
• Assists with note taking and documentation at meetings as requested
• Other administrative / non-clinical duties as needed to support CM and Health Management Department functions.

Education / Experience :

• Associates Degree or equivalent combination of education and experience
• 2 years of managed care experience
• Call center experience in a call center preferred
• Experience with care management / community resources preferred

Required License(s) and / or Certification(s) :

Medical Assistant Certification preferred

Skills / Knowledge / Competencies (Behaviors) :

• Demonstrates an understanding of and alignment with Martin's Point Values.
• Basic knowledge of medical terminology.
• Basic knowledge of current healthcare benefits and managed care insurance plans.
• Knowledge of CMS and NCQA regulations a plus.
• Strong organizational skills (ability to prioritize and multi-task in a high-pressure environment while maintaining focus on organization objectives).
• Ability to take direction from multiple individuals and prioritize tasks appropriately to meet deadlines.
• Ability to handle confidential and sensitive information in a discreet and professional manner.
• Effective customer service skills for use with both members and providers.
• Demonstrated technical skills in use of office systems, electronic heath records, and databases.
• Basic knowledge of Microsoft Word and Excel.
• Ability to function independently.
• Critical thinking : Can identify root causes and suggest creative solutions.
• Takes appropriate initiative while soliciting input / advice appropriately.
• Ability to collaborate with all internal departments and staff with dedication to customer satisfaction.
• May need to be available on a phone queue between 8am and 430pm as needed to support the CM nurses and social workers.

There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

We are an equal opportunity / affirmative action employer.

Do you have a question about careers at Martin's Point Health Care? Contact us at : [email protected]