Care Management Representative, Care Management, Full Time, Days

Prisma Health; Columbia (SC); On-site; USD 36,000 - 54,000; Full time

Job summary

Prisma Health Richland is seeking an Administrative Care Coordination Specialist to support Care Managers and Health Coaches by handling intake, enrollment, scheduling, and outreach to members. This role acts as a central intake resource and helps coordinate planning and monitoring activities for patients in the Ambulatory Care Management program.

The position emphasizes telephonic engagement, appointment scheduling, and collaboration with PCPs.

Qualifications

• Associate degree in nursing, social work or healthcare-related field.
• Bachelor's degree in healthcare-related field preferred.
• Two years of strong customer service handling confidential health information.

Responsibilities

• Engages members by initiating telephonic outreach and enrollment into care management programs.
• Handles inbound calls to enroll, provides outbound calls as needed, and informs members.
• Manages mailings and outreach communications and tracks enrollment status.
• Assists in scheduling all Care Manager follow-up appointments.
• Contacts PCPs/Specialists to inform them of member enrollment and services.
• Organizes community services as needed and monitors cases after closure.
• Performs other duties as assigned.

Skills

Customer Service

EMR Experience

Healthcare Knowledge

Education

Associate degree in Nursing, Social Work, or healthcare related field

Bachelor's degree in healthcare related field preferred

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary Functions as a core team member of the care team pod, completing administrative and other programmatic supportive tasks vital to the clinical care coordination programs. Serves as non-clinical support to Care Managers and Health Coaches, with flexibility to serve the extended care coordination team pods, based on the care needs of patients/members for the shared population. Plays a key role in initial engagement with members, acting as a central intake resource, obtaining members agreement to participate in the program, scheduling of assessments, assisting in care plan activities created by the Care Mangers and Health Coaches, and monitoring activities for members who meet defined monitoring criteria after management cases have been closed by Care Managers and Health Coaches. Promotes proactive coordination of services to other programs and supports members receiving care from community services.
Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference


• Conducts telephonic outreach to members to engage and enroll members into the care management programs.


• Takes inbound calls from members seeking to enroll, provides inbound backup for CM calls, and responsible for outbound calls to appropriate patients.


• Manages all mailings and outreach correspondence to members and provides enrolment status, opt-out and inability to reach correspondence to providers.


• Supports scheduling of all appointments for Care Managers follow up.


• Contacts PCP/Specialist to inform them of attributed member enrollment in complex care program and any additional program/services.


• Organize and establish community services as needed and appropriate by the member and Care Manager.


• Monitors closed cases steered from complex care management based on defined monitoring criteria.


• Performs other duties as assigned.

Supervisory/Management Responsibility

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - Associate degree in Nursing, Social Work, or healthcare related field of study. Bachelor's degree in healthcare related field preferred.


• Experience - Two (2) years of strong customer service experience handling confidential health information. Health system experience and experience with EMR (electronic medial records) preferred.

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills And Abilities

• NA

Work Shift Day (United States of America)
Location Richland
Facility Value-Based Care and Network Services
Department Ambulatory Care Management
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