Care Management Support Coordinator II

Immediate need for a talented Care Management Support Coordinator II. This is a 06+ months contract (Possible Extension or conversion) opportunity with long-term potential and is located in McAllen, TX (Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job ID:25-79527
 
Pay Range: $16.50 - $17/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:

• Training: During training period 3-4 weeks in person. After that remote but may have to go back to McAllen office upon business needs.
• All interactions with members are done telephonically."              "Provides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service.
• Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service.
• May apply working knowledge of assigned health plan(s) activities and resources.
• Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols.
• Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship.
• Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed.
• Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health (SDOH) needs.
• Performs other duties as assigned.
• Complies with all policies and standards.
• Call center type role, making outbound and receiving inbound calls (daily goal of at least 30 members or more per day).
• Speaking with members and legal representatives
• Purpose of call: to schedule assessments
• Initiate authorization requests for output or input services in keeping with the prior authorization list.
• Research claims inquiry specific to the department and responsibility.
• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results.
• Assess and monitor inpatient census.
• Screen for eligibility and benefits.
• Identify members without a PCP and refer to Member Services.
• Screen members by priority for case management (CM) assessment.
• Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
• Coordinate services with community-based organizations.
• Attend marketing and outreach meetings as directed to represent the plan.
• Produces and mails routine CM letters and program educational material. Data enter assessments and authorizations into the system.

Key Requirements and Technology Experience:

• Key Skills: Customer Service, Spanish/Bilingual & Medicaid/Medicare.    
• High School diploma or GED.
• 1 – 2 years of related experience.
• Microsoft Office.
• 28 members/day (attempting to schedule or actually scheduling them).
• Strict turnaround time for this department – if not met, subject to potential damages by the state.
• Fast-paced environment and expected to follow up within a certain timeframe.
• High call volume experience. Need to be comfortable with this, does not necessarily need the experience previously.
• Previous appointment scheduling experience
• Bilingual (Spanish) required.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
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