Care Management Associate I

Metroplushealth • Bowling Green, NY

302d

About The Position

The Care Management Associate, under the direction of the CMA Supervisor, is responsible for the daily activities of the member case intake functions and associated workflow, as well as for performing other duties associated with the coordination of member care as outlined for the MLTC/PCS Team.

Requirements

• High School graduation or evidence of having satisfactory passed a High School Equivalency Program.
• One year of satisfactory full-time experience.
• Understanding of Medical terminology preferred.
• Knowledge of ICD-9 and CPT-4 codes preferred.
• Prior managed care experience preferred.
• Prior experience in customer services/call center preferred.

Nice To Haves

• Integrity and Trust.
• Customer Service Focus.
• Functional/Technical skills.
• Written/Oral Communications.

Responsibilities

• Handles both incoming and outgoing calls on the MLTC/PCS ACD.
• Schedules appointments for Care management staff.
• Maintains files on members and tracks status of membership.
• Acts as a liaison between MetroPlus and HHA/PCA vendors regarding communication about service to members.
• Assists members in scheduling necessary medical visits.
• Enters prior approvals in the authorization System (CareConnect).
• Uses CareConnect system to enter authorization or services as per benefit of the program.
• Notifies vendors of the start date of the services to member.
• Notifies vendors of end of or cancellation of services for member.
• Monitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requests.
• Tracks and monitors key information identified by the Team Lead for quality purposes.
• Tracks and monitors members' admission to hospitals, nursing home facilities, ER visits and unexpected outcomes.
• Tracks and monitors members' documentation required for authorization and re-authorization of Personal Care Services.
• Coordinates the completion of Doctor's orders or M11qs.
• Prints and mails Home Health Aide/Personal Care Aide Plan of Care.
• Tracks member's short-term absence from geographic areas.
• Coordinates the completion of Occupational Therapy Evaluations.
• Notifies Care Manager if a member cannot be contacted.
• Completes missing information from documentation received.
• Confirms conflicting information accuracy in the documentation.
• Performs all other tasks assigned by the Team Lead or the management team.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED