Job Description:

• Create cases, tasks, and complete documentation in the Case Management module for all Hospital and SNF discharges
• Reach out to members telephonically to assist with referrals, authorizations, home health care (HHC), durable medical equipment (DME), medication refills, and scheduling provider appointments and follow-ups
• Request and upload medical records from PCPs, specialists, hospitals, and other providers, including discharge summaries
• Work as a team with the RN Case Manager to engage and manage a panel of members
• Manage new alerts and update the Case Manager of changes in condition, admission, discharge, or new diagnoses
• Complete and document tasks assigned by nurse
• Establish relationships with members, earn their trust, and act as a patient advocate
• Escalate concerns to nurse if members appear to be non-compliant or there is a change in condition
• Assist with outreach activities to members across all levels of case management programs
• Assist with maintaining and updating member records
• Assist with mailing or faxing correspondence to members, primary care physicians (PCPs), and/or specialists
• Meet specific deadlines by prioritizing tasks according to department policies, standards, and business needs

Requirements:

• Minimum 1 year of experience in care coordination, case management, or transitions of care within a health plan, IPA, MSO, or medical office setting
• Experience supporting members/patients with scheduling, authorizations, referrals, and coordination of services (e.g., home health, DME, follow-up care)
• Experience interacting directly with patients/members in a telephonic or care coordination setting
• Required: High School Diploma or GED and / or (4) years' relevant experience in lieu of education.
• Preferred: Bachelor's degree
• Required: Bilingual English and Spanish
• Proficient Computer Skills, Able to type 35 WPM by 10-key touch (Microsoft Outlook, Excel, Word)

Benefits:

• None listed