Sr Care Management Assistant - remote (PA/NJ/DE) (Healthcare)

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Under the supervision of the Manager, Case Mgr Behavioral Health the Sr Care Management Asst will provides administrative support to the clinical Case Management team.  Responsibilities include triage of Customer Segment Task list, outreach to members.

MAJOR ACTIVITIES:

1. Reviews and processes case and condition management referrals from Customer Segment task lists per guidelines.   
2. Review task note and members' discharge status to prioritize work schedule.
3. Check members' eligibility and demographic information.
4. Outreach call to members following Case Management guidelines
   • Appropriate and thorough documentation of referral and calls in medical management system utilizing standard documentation
   • Introduce case management program and upon acceptance, schedule appointment at members' convenience or warm transfer to a registered nurse case manager.  
   • Any immediate need or crisis identified  is transferred to clinical designee (Sr. CMA MUST REMAIN ON LINE TO ANNOUNCE CALL)
   • If  call is unsuccessful, Sr. CMA follows the appropriate failure to contact process and generates letter
   • If appointment is scheduled, Sr. CMA will add appointment time to case manager's outlook calendar and generates a task per guidelines.
   • If warm transfer. Sr. CMA transfers member to case manager and generates a task per guidelines. 
   • When unable to reach member, or member declines, document in medical management system as per guidelines.
   • Documentation is in compliance with NCQA guidelines 
5. Develop tickler list for next business day, which includes any unfinished tasks.
6. Complete weekly and monthly stats.
7. Functions as Preceptor to new Care Management Assistants
8. Retrieves and processes voice mails and external case management referrals per guidelines. 
9. Other duties as assigned

Education and Experience:

• High school diploma, degree preferred. 
• Computer skills required. 
• Prior experience as CMA or Precertification Specialist position preferred. 
• The incumbent must be able to learn quickly, think logically, possess a problem-solving aptitude and understand the relationship between the IBC Family of Companies and Managed Care Programs. 
• Attention to detail and accuracy is crucial. 
• This position requires excellent customer services skills including an understanding of medical terminology in order to provide the best service to members and case management staff. 
• The incumbent must be computer-literate and able to research problems.

Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

 

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

 

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.