Care Management Representative, Care Management, Full Time, Days

Prisma Health; Columbia (SC); On-site; USD 36,000 - 48,000; Full time

Job summary

Prisma Health is seeking a non-clinical care coordination support role within Ambulatory Care Management. You will assist Care Managers and Health Coaches, serving as a central intake resource and helping enroll members into programs.

You will schedule assessments, monitor defined criteria for active cases, and coordinate services with community providers to promote proactive care and timely follow-up.

Qualifications

• Two years of strong customer service experience handling confidential health information.
• EMR (electronic medical records) experience preferred.
• Bachelor's degree in healthcare related field preferred.

Responsibilities

• Provides telephonic outreach to engage and enroll members into care management programs.
• Manages inbound/outbound calls for enrollment and follow-up with patients.
• Handles mailings and outreach correspondence, updating enrollment status and opt-out options.
• Assists in scheduling all follow-up appointments for Care Managers.
• Contacts PCP/Specialists to inform them of enrolled members in complex care programs.
• Organizes and coordinates community services as needed by members and Care Managers.
• Monitors closed cases based on defined monitoring criteria.
• Performs other duties as assigned.

Skills

Customer service

Communication

Education

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

Bachelor's degree in healthcare related field

Tools

EMR (Electronic Medical Records)

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

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.