This position is responsible for providing customer service and support to case management department by handling case management referrals that are received from multiple sources. Duties include performing member benefit eligibility verification, CM letters notification letters, and processing case management referrals per Health Integrated guidelines. This position also will be responsible for providing timely outreach to members for engagement in case management programs. CM Clinical Support Associate is responsible for delivery of letters, both automated and manual, and medical records a requested by case manager. The CM Clinical Support Associate will assist with scheduling/transferring potential members with case managers. Each CM Clinical Support Associate must ensure that all required data elements are captured in clinical information management system, with special attention to HIPAA compliance, data quality and client satisfaction while handling calls from providers and members regarding Case Management services. CM Clinical Support Associate position requires subject matter expert knowledge and will be responsible for training on all customer accounts, all client and internal systems.
● 50% Delivers professional customer service to members, providers, and clients in accordance with all policies and procedures. Must maintain or exceed minimum performance standards as defined in goals document. Basic standards include accuracy, call metrics, attendance, and customer satisfaction.
● 20% Functions as a subject matter expert and is responsible for training staff on all customer accounts, all client and internal systems.
● 10% Performs all administrative functions as required in our contractual agreements with our clients.
● 10% Maintains current policy and procedure information by self-study of corporate resources; attending training sessions; and by seeking knowledge.
● 10% Accountable for creating and fostering a team environment through participation in team activities; individual morale; willingness to pitch in and help with special projects and to be a part of the solution.
DSNP responsibilities include:
• Identification and publication of daily inpatient census
• Identification and publication of daily discharge census
• Initiate, update and complete the Transition Process for all inpatient members
• Sending of all care plans generated by clinician staff to appropriate location
• Warm transfer of member to assigned clinician/and or customer service
• Initiate ICT log and transfer ICT recommendations to Electronic Medical Record
• Monitor turn-around times for all client performance metrics and notify Supervisor Staff of any risks to compliance
• Outreach unable to reach members for HRA completion
This position is responsible for:
• Quality service delivery;
• Maintaining quality, productivity and procedures as defined by applicable policies and procedures
• Meeting all individual and team performance metrics, including but not limited to; call quality, average handle time, schedule adherence and attendance.
• Support all Model of Care requirements and components
• Demonstrated ability to type 50 words per minute with 90% accuracy while engaged in a telephone conversation
• Demonstrated proficiencies with basic computer skills to include how to navigate, accessing of various programs and use of Microsoft Outlook email
• Must be an effective communicator, both written and verbally – able to clearly articulate information to both providers and members
• Demonstrated success in a call center environment to include multi-tasking as well as the ability to focus singularly on the task at hand
• Must be flexible, willing to accept changes occurring in a dynamic environment
High School Diploma or GED required.
Two years of advanced education/college or graduation from an accredited business school preferred
Work Experience Requirements:
Minimum two years health insurance environment experience required. Experience in managed healthcare environment preferred. Multiple systems use; recent managed care; physician office; hospital business office or health care industry background in customer service desired. Knowledge of medical and/or behavioral terminology is preferred.