Care Management Associate - Mltc

Position Overview:

The Care Management Associate, under the direction of the CMA Supervisor, is responsible for the daily activities of the member case intake functions and associated workflow, as well as for performing other duties associated with the coordination of member care as outlined for the MLTC/PCS Team.

• Handles both incoming and outgoing calls on the MLTC/PCS ACD
• Schedule appointments for Care management staff
• Maintain files on members and tracked the status of membership
• Liaison between MetroPlus and HHA/PCA vendors re: communication about service to members
• Assist members in scheduling necessary medical visits.
• Enter prior approvals in the authorization System (CareConnect).
• Use CareConnect system to enter authorization or services as per the benefit of the program.
• Notifies vendors of the start date of the services to member.
• Notifies vendors of end of or cancellation of services for members.
• Monitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requests
• Tracks and monitors key information identified by the Team Lead for quality purposes.
• Track and monitor members’ admission to hospitals, nursing home facilities, ER visits and unexpected outcomes
• Track and monitor members’ documentation required for authorization and re-authorization of Personal Care Services. This includes coordinating the completion of Doctor’s orders or M11qs
• Print and mail Home Health Aide/Personal Care Aide Plan of Care
• Track member’s short-term absence from geographic areas.
• Coordinate the completion of Occupational Therapy Evaluations
• Notifies the Care Manager if a member cannot be contacted.
• Complete missing information from documentation received
• Confirm conflicting information accuracy in the documentation
• All other tasks assigned by the Team Lead or the management team.

Minimum Requirements:

• High School graduation or evidence of having satisfactorily passed a High School Equivalency Program
• One year of satisfactory full-time experience.
• Understanding of Medical terminology is preferred. Knowledge of ICD-9 and CPT-4 codes preferred.
• Prior managed care experience preferred.
• Prior experience in customer services/call center experience preferred.

Professional Competencies:

• Integrity and Trust
• Customer Service Focus
• Functional/Technical skills
• Written/Oral Communications

Job Type: Full-time

Pay: $50,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience level:

• 1 year
• 3 years

Healthcare setting:

• Acute care
• Clinic
• ER
• Hospital
• Operating room

Schedule:

• Day shift
• Monday to Friday

Ability to Relocate:

• New York, NY 10004: Relocate before starting work (Required)

Work Location: Hybrid remote in New York, NY 10004