Care Management Associate

Pride Health; New York (NY); On-site; USD 21,000 - 32,000; Full time

Benefits offered by this job

Healthcare coverage

Supplemental coverage

401(k) retirement

Life & disability insurance

Employee assistance program

Legal support

Auto insurance

Home insurance

Pet insurance

Employee discounts

Job summary

Pride Health is seeking a customer-focused call center professional to support MLTC/MAP/PCS members in New York. You will handle incoming/outgoing calls and assist with scheduling medical visits, while maintaining accurate member files and status updates.

You will liaise with hospitals and vendors to coordinate benefits and services, enter authorizations, and monitor queues for timely processing. Prior health plan experience is a plus.

Qualifications

• Minimum 1 year of full-time direct consumer contact experience.
• Understanding of medical terminology preferred.
• Knowledge of ICD-10 and CPT-4 codes preferred.
• Prior managed care experience preferred.
• Prior call center experience required.

Responsibilities

• Handle incoming and outgoing calls for MLTC/MAP/PCS member support.
• Schedule appointments for Care Management staff and assist members with scheduling necessary medical visits.
• Maintain member files and track membership status, admissions, ER visits, nursing home stays, and short-term absences.
• Serve as a liaison between hospitals and HHA/PCS/CDPAS vendors regarding member benefits and services.
• Enter prior approvals and service authorizations into authorization systems and monitor assigned queues for timely processing.
• Track required member documentation for authorization and re-authorization of Personal Care Services, including Doctor’s Orders and M11Qs.
• Notify vendors of service start dates, service end dates, or cancellations and report trends or issues to the Care Manager/Supervisor.

Skills

Customer service

Call center experience

Medical terminology

ICD-10 CPT-4 knowledge

Education

High School Diploma

Tools

Authorization systems

Job description

Required Education, Training & Professional Experience:

• High School graduation or evidence of having satisfactorily passed a High School Equivalency Program
• One year of satisfactory full-time experience in direct consumer contact.
• Understanding of Medical terminology preferred.
• Knowledge of ICD-10 and CPT-4 codes preferred.
• Prior managed care experience preferred.
• Prior experience customer services/call center experience required.

Duties:

Handle incoming and outgoing calls for MLTC/MAP/PCS member support.

Schedule appointments for Care Management staff and assist members with scheduling necessary medical visits.

Maintain member files and track membership status, admissions, ER visits, nursing home stays, and short-term absences.

Serve as a liaison between hospitals and HHA/PCS/CDPAS vendors regarding member benefits and services.

Enter prior approvals and service authorizations into authorization systems and monitor assigned queues for timely processing.

Track required member documentation for authorization and re-authorization of Personal Care Services, including Doctor’s Orders and M11Qs.

Notify vendors of service start dates, service end dates, or cancellations and report trends or issues to the Care Manager/Supervisor.

Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Pride Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Pride Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates:

Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.