About the Role
The Case Management Coordinator solicits and documents general health information from members to ensure effective management of health conditions and psychosocial conditions via referral process to promote population health management.
Essential Functions:
Verify member eligibility, enrollment status, demographic data and current health / psycho-social needs status
Engage with members using professional and effective communication process via telephonic or electronic contact
Assist members with non-clinical questions relating to completion of HRA questionnaire
Provide program or campaign support and assistance through engagement of special population members to multiple markets / requires personal adaptability and receptiveness to change
Provide educational material and resources to members utilizing multiple delivery methods which could include telephone, email, member portal, and mail services.
Research and resolve campaign specific member Rewards & Incentive questions and issues in a timely manner
Accurately complete and maintain documentation and based on answers to the screening, transfer qualified members to the appropriate queue for coordination of care or provide appropriate educational intervention
Educate member on wellness programs and appropriately refer to case manager for additional assistance when needed
Accurately document information and maintain manual data reports as requested by campaign
Refer and assist members to access community services and collaborate continuously with leadership on identification and documentation of updated resources
Coordinate intake process for provider referrals and member opt-in self-referrals for disease health coaching program
Assist in short and long-term outreach programs to complete specific projects related to outreach to providers and identified special populations
Review identified member specific well care or preventative needs (HEDIS Flags)
Maintain appropriate and accurate documentation of telephone or electronic communication to ensure compliance with all state and federal reporting requirements and quality assurance standards
Routinely use multiple internal computer applications and telephonic systems to provide assistance to members
Perform any other job duties as requested
Education and Experience:
High School Diploma or equivalent is required
Associate’s Degree or other formal health education / certification is preferred
Minimum of three (3) years of experience in healthcare, customer service or a related industry is required
Previous experience in a clinical environment, medical terminology or health related classes is preferred
Requirements
Education and Experience:
High School Diploma or equivalent is required
Associate’s Degree or other formal health education / certification is preferred
Minimum of three (3) years of experience in healthcare, customer service or a related industry is required
Previous experience in a clinical environment, medical terminology or health related classes is preferred
Competencies, Knowledge and Skills:
Basic proficiency with Microsoft Office Suite to include Outlook, Word and Excel
Knowledge of Medicaid, Medicare and Managed Care is preferred
Customer service focus with exceptional listening, written and verbal communication skills
Displays professional phone etiquette
Ability to multitask using a variety of computer applications
Strong organizational skills
Effective problem solving skills with attention to detail
Ability to work independently and within a team environment
Understanding and supportive of managed care concept
Adaptable to a constantly changing environment
Able to type (document) and talk (telephonically) simultaneously
About the Company
RepuCare is a certified Woman Owned Business (WBE) and a driving force behind innovative workforce solutions. We team with clients, both large and growing, to provide top-tier talent in the healthcare, IT, and engineering fields.