Care Management Support Specialist

Healthfirst; Pennsylvania; On-site; USD 35,000 - 52,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Life insurance

401k contributions

Incentive programs

Job summary

Healthfirst in Pennsylvania is seeking a Support Coordinator to assist care/case managers with non-clinical tasks such as creating cases, conducting telephonic outreach to members, providers, and community organizations, and handling member mailings and care plan documents.

The role supports a specific clinical team and may perform duties across departments, educating members and providers on service approvals, and managing a large caseload with documentation of authorizations and communications.

Qualifications

• High School diploma or GED equivalent.
• Experience in a customer service environment.
• Experience working in a fast-paced environment that requires handling multiple priorities simultaneously.
• Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills.

Responsibilities

• Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requests.
• Review intake documents for pre-approved services and elevate discrepancies as needed.
• Complete Welcome Onboarding and Consumer Directed Personal Assistant Assessments and identify any issues or risk factors that require clinical escalations to a CM/PCM.
• Initiate and finalize authorization in Trucare for preapproved services and DMEs and update and discontinue authorizations when applicable.
• Handle and accurately document calls to and from members to assist with benefit questions/issues, schedule appointments, assessment inquiries, service issues and grievances.
• Handle and accurately document calls to and from providers regarding authorizations initiation/updates, referrals, visits, tests, and faxed care plans.
• Provide education to members and providers regarding requirements for approval of service requests.
• Manage a large caseload while communicating member issues or needs and monitoring screening of members effectively to improve quality and cost outcomes.
• Communicate with Inter/Intra-departments regarding reconciling onboarding issues.
• Additional duties as assigned

Skills

Customer service

Communication

Multitasking

Written communication

Education

Associate Degree/Certification in a related field

Tools

Trucare

Salesforce

HHAXchange

DocuSign Epaces

Sharepoint

Job description

Healthfirst in Pennsylvania is seeking a Support Coordinator to assist care/case managers with non-clinical tasks such as creating cases, conducting telephonic outreach to members, providers, and community organizations, and handling member mailings and care plan documents.

The role supports a specific clinical team and may perform duties across departments, educating members and providers on service approvals, and managing a large caseload with documentation of authorizations and communications.