Analyst - Case Management Specialist
- Description:
- The Care Manager is responsible for the care management of members that are enrolled in the Dual Special Needs Plan and have limited health conditions.
- Work in conjunction with the Nurse Care Manager, Care Coordinator, Transition of Care (TOC) Coach, and other members of the Care Team to improve the member’s health outcomes.
- Assess member’s needs and gaps in care, communicate with the member’s Primary Care Provider (PCP), maintain updated individualized care plans and participate in Interdisciplinary team meetings.
- Identify members whose needs require clinician involvement and transition members appropriately.
- Responsible for interacting with low stratification members via phone calls, coordinating care, completing, reviewing, and updating assessments and care plans.
- Requirements:
- 3+ years experience in health-related field
- 2+ years of customer service experience
- 2+ years of experience with claims
- Preferred Qualifications: CRC, CDMS, CRRN, COHN, or CCM certification
- Medicare and Medicaid experience
- Managed care experience
- Experience working with geriatric special needs, behavioral health and disable population
- Effective computer skills including navigating multiple systems and keyboarding
- Knowledge of assessment, screenings, and care planning
- Bilingual (English/Spanish; English/Creole)
- Benefits:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
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