Care Management Associate

• Handles both incoming and outgoing calls on the MLTC/PCS ACD 
• Schedule appointments for Care management staff
• Maintain files on members and tracks status of membership 
• Liaison between Health and HHA/PCA vendors re: communication about service to members
• Assist members in scheduling necessary medical visits.
• Enter prior approvals in the authorization System (CareConnect).
• Use 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.
• Track and monitor members’ admission to hospitals, nursing home facilities, ER visits and unexpected outcomes 
• Track and monitor members’ documentation required for authorization and re-authorization of Personal Care Services. This includes coordinating the completion of Doctor’s orders or M11qs
• Print and mail Home Health Aide/Personal Care Aide Plan of Care 
• Track member’s short-term absence from geographic areas. 
• Coordinate the completion of Occupational Therapy Evaluations 
• Notifies Care Manager if a member cannot be contacted.
• Complete missing information from documentation received 
• Confirm conflicting information accuracy in the documentation 
• All other tasks assigned by the Team Lead or the management 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 customer services/call center experience preferred.