Care Specialist

Emblem Health • Farmington, CT

333d • $36,100 - $50,000

About The Position

The position is responsible for the execution of the non-clinical aspects of the Care Management process. This includes ensuring that information is appropriately entered into the system to effectively execute member care plans, originate authorizations, request clinical information, perform case research, and manage all behind-the-scenes desk-level procedures of a case. The role requires seamless collaboration with Care Specialists, Care Managers, Social Workers, and other clinical staff to ensure that all participant health needs are addressed. Additionally, the position provides confidential administrative support to the department and assists in daily project operations. Telephonic outreach to members identified for care management is also a key responsibility, ensuring that members' needs are supported throughout their enrollment in the program by completing screenings, coordinating care plans, making referrals, and assisting with community resource needs.

Requirements

• Bachelor's Degree required; additional experience/certifications/training may be considered in lieu of educational requirements.
• Medical Assistant certification preferred.
• 1 - 2+ years of previous client-facing or data entry experience in a health care environment required.
• Strong verbal, written, and interpersonal communication skills required.
• Ability to work both independently and collaboratively with others required.
• Previous system user experience in a highly electronic environment required.
• Proficiency in MS Office (Word, Excel, PowerPoint, Teams, Outlook, etc.) required.
• Knowledge of medical terminology and medical payment preferred.
• Ability to prioritize multiple tasks required.
• Ability and willingness to work a flexible schedule including weekends, nights, and holidays as needed required.

Responsibilities

• Work collaboratively as a critical component of the Medical Management team to facilitate clerical and administrative processes.
• Perform accurate and timely intake and data entry for all Care Management requests and referrals.
• Conduct member telephonic outreach for program enrollment to retain members in the Care Management Program.
• Triage cases and assign receipts to appropriate teams.
• Communicate and respond to inquiries from providers, facilities, and members.
• Initiate member and provider correspondence and verbal outreach according to departmental guidelines.
• Enter and maintain documentation in electronic records, meeting defined timeframes and performance standards.
• Manage phone queues for incoming and outgoing calls.
• Perform other related projects and duties as assigned.
• Under the direction of a Care Manager, manage caseload and update care plans for low and moderate risk members.
• Support care interventions including making doctor's appointments, health coaching, and referrals.
• Leverage motivational interviewing skills to identify members' needs and support care plans.
• Conduct research and educational outreach activities to encourage healthy behaviors and facilitate gap closure in care.
• Adhere to processes for collecting member-specific clinical and demographic data.
• Support communication and coordination with delegated entities as necessary.
• Coordinate with community-based organizations to identify available resources.
• Actively participate in assigned committees and projects.
• Additional tasks and duties as required.
• Required to work weekends, nights, and holidays as necessary.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees