The Care Management Assistant/SSC assists the clinical Case Manager in both Utilization and Case Management for the integration and coordination of a members care.
Provides telephonic follow up with members for Case Management services to include post hospital discharge and chronic condition management.
Coordinates with the case management team, and Provider,(when indicated by the Case Manager) to assist in the attainment of members goals by:
working with member, physician, other Health care providers and the case manager, meeting the member’s individual needs based on protocols and referrals
supporting the member education goals regarding their specific chronic condition based on the Plan of Care;
educating the member how to access the benefits;
assisting in the arrangement of Provider follow-up appointments;
mailing of approved educational and informational materials;
assisting in the performance of “Welcome Home” calls to members post discharge from inpatient or other levels of care as directed and supervised by the licensed Case Manager;
supporting the monitoring and evaluation of interventions as set and directed by the clinical Care Manager in the Plan of Care by periodic telephonic contact with members based upon data received pertinent to members chronic conditions or other risk triggers, ie; ED visits, IP acute stay, referral for outpatient cardiac procedure.
Case Management Assistants/SSC must remain objective in their review and not participate in any way in the delivery of care to the patient and:
comply with all departmental policies and procedures;
participate in departmental and company in-services as appropriate;
perform other duties as assigned by the Case Manager;
document as required according to policy and procedure.
Administers tasks as detailed in the member specific Plan of Care, under the direction of the clinical Case Manager.
Complies with Customer Service expectations as applicable to the Department and Health Plan.
And all other duties assigned by manager or supervisor.
Strong organizational and time management skills, able to work with little supervision while handling numerous projects at once
Excellent written/verbal communication skills, especially the ability to communicate telephonically in a professional and effective manner
Computer literacy in Word, Excel
Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization
High school graduate
Healthcare related experience is preferred
Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.
Universal American Financial Corp - 20 months ago