Care Specialist

EmblemHealth; New York (NY); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading health insurance company is seeking a Care Specialist to manage non-clinical aspects of the Care Management process. You will collaborate with Care Managers and Social Workers, providing essential administrative support, conducting outreach to members, and ensuring care plans are effectively executed. This entry-level, full-time position requires strong communication skills and the ability to manage multiple tasks efficiently.

Qualifications

• 1-2 years of previous client-facing or data entry experience in a health care environment.
• Strong oral, written, and interpersonal communication skills required.
• Ability to prioritize multiple tasks.

Responsibilities

• Perform accurate and timely intake and data entry for all Care Management requests.
• Communicate and respond to inquiries from providers, facilities, and members.
• Support care interventions including making doctor’s appointments and health coaching.

Skills

Communication

Teamwork

Data Entry

Education

High School Diploma

Associate Degree or Medical Assistant certification

Bachelor's in related field

Tools

Microsoft Office

Job description

Join to apply for the Care Specialist role at EmblemHealth

14 hours ago Be among the first 25 applicants

Join to apply for the Care Specialist role at EmblemHealth

Summary Of Position

Responsible for the execution of the non-clinical aspects of the Care Management process. Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations, request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a case. Work seamlessly with the Care Specialists, Care Managers and Social Workers (and other clinical staff) to ensure everything that a participant needs to tend to their health is addressed. Provide confidential administrative support and assistance to the department and support the department in all aspects of daily project operations. Assist the entire Care Management interdisciplinary team in managing members with Care Management needs. Provide telephonic outreach to members that have been identified for care management and ensure members’ needs are supported throughout the duration of member enrollment to the program, by completing screenings with members, coordinating with Care Manager on members’ care plan, making appropriate referrals to the interdisciplinary care team, coordinating post-acute services on behalf of members, assisting with community resource needs and more.

Summary Of Position

Responsible for the execution of the non-clinical aspects of the Care Management process. Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations, request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a case. Work seamlessly with the Care Specialists, Care Managers and Social Workers (and other clinical staff) to ensure everything that a participant needs to tend to their health is addressed. Provide confidential administrative support and assistance to the department and support the department in all aspects of daily project operations. Assist the entire Care Management interdisciplinary team in managing members with Care Management needs. Provide telephonic outreach to members that have been identified for care management and ensure members’ needs are supported throughout the duration of member enrollment to the program, by completing screenings with members, coordinating with Care Manager on members’ care plan, making appropriate referrals to the interdisciplinary care team, coordinating post-acute services on behalf of members, assisting with community resource needs and more.

Responsibilities

• Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities.
• Perform accurate and timely intake and data entry for all Care Management requests and referrals for all lines of business, upon receipt of inbound requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements.
• Perform member telephonic outreach for program enrollment with the goal of retaining members in the Care Management Program.
• Triage cases and assign receipts to appropriate teams.
• Communicate and/or respond to inquiries from providers, facilities and members.
• Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
• Enter and maintain documentation in electronic record, meeting defined timeframes and performance standards.
• Provide phone queue management for both incoming and outgoing calls.
• Perform other related projects and duties as assigned.
• Under the direction of a Care Manager, manage caseload and update care plans for low and moderate risk members in collaboration with the clinical team.
• Support care interventions including making doctor’s appointments, health coaching, referrals to internal and external resources, assist with transportation issues.
• Leverage motivational interviewing skills and a member-centric approach to identify members’ needs, prioritize and support care plan.
• Perform a wide range of research and educational outreach activities to encourage healthy behaviors, such as outreaching to identified members who need a primary care provider or who may have gaps in care related to recommended tests or provider visits and facilitate gap closure and receipt of evidence-based care.
• Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
• Support communication and coordination with delegated entities, as necessary.
• Coordinate directly with community-based organizations and agencies to identify available and/or alternative resources for a wide range of concerns, including home safety, financial assistance, caregiver support and transition assistance.
• Actively participate in assigned committees and projects.
• Additional tasks and duties as required.
  
  

Qualifications

• High School Diploma required
• Associate Degree or Medical Assistant certification preferred
• Bachelor’s in related field preferred
• At least 1-2 years of previous client-facing or data entry experience in a health care environment
• Additional years of experience/certifications/training may be considered in lieu of educational requirements
• Strong oral, written and interpersonal communication skills required
• Ability to work both independently and collaboratively with others
• Previous system user experience in a highly electronic environment required
• Proficiency in Microsoft Office suite skills required
• Knowledge of medical terminology and medical payment preferred
• Ability to prioritize multiple tasks
• Required to work weekends, nights and holiday as necessary
  
  

Additional Information

• Requisition ID: 1000002550
• Hiring Range: $19.21-$33.75 per hour

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

Referrals increase your chances of interviewing at EmblemHealth by 2x

Sign in to set job alerts for “Care Specialist” roles.

Medical Assistant/Front Desk Coordinator

New York, NY $100,000.00-$120,000.00 1 week ago

Sales Assistant / Front Desk Receptionist

Medical Front Office / Patient Care Coordinator Part Time

New York, NY $62,868.00-$72,298.00 1 week ago

Office Coordinator-Mount Sinai Doctors Medical Group

Scheduling Coordinator I-FPA Access Center

Scheduling Coordinator - Cardiac Surgery

Bronx, NY $80,000.00-$80,000.00 3 weeks ago

New York, NY $75,000.00-$95,000.00 3 weeks ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.