Collection of data and assessment of members; collaborates with Care management nurses, social worker, Back Care coordinator, nutritionist and sleep apnea/respiratory therapist to facilitate member's participation; provide outreach/education to members to encourage self management and enroll members in care management programs.
Primary Job Duties:
- Receives referrals for members in need of management from internal/external sources and assign to team members for initial phone call.
- Analyzes data on member/eligibility/ disease state/claims to determine if member meets criteria for case or disease management.
- Calls members to complete assessment and explain programs to member. Encourages member to participate in programs related to health/wellness. Assigns and schedules member for Disease or Case manager as appropriate based on information received from member assessment.
- Provides program information to members, providers, community groups and hospitals to promote programs. Identifies barriers to care and communicates to RNs, social worker, nutritionist, back care coordinator, sleep apnea/respiratory therapist as appropriate. Participates in community activities to promote health and public awareness of programs.
- Collaborates with team to share information and develops additions/revisions to work flow. Delegates assignments. Acts as preceptor to new staff members. Document as appropriate utilizing BCBS information systems.
- Performs other related duties as requested.
- Ability to function as part of a team approach
- Excellent communication skills
- Strong interpersonal skills.
- Ability to work independently
- Maintains confidentiality
- Proficient computer skills in MS Word, Excel, PowerPoint
- Respects diversity
- Work schedule may vary depending on external commitments.
LPN, Medical Assistant - LPN or Medical Assistant is required. Minimum 2 years experience in MD office/clinic, hospital setting or community agency preferred.
3-5 years experience in healthcare setting (MD office, clinic hospital, acute, outpatient, SNF social services agency)
- Must be able to work in an office environment
- Must be able to accommodate local travel. Valid drivers license and acceptable driving history required due to travel involved with this position (DMV check will be conducted to review candidate's driving record)
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
- PPD Skin Test may be required by healthcare facility for onsite facility work
- Driver's License/DMV Check Required
HealthNow New York Inc. - 19 months ago