Under the direct supervision of the Lead Case Management Coordinator and RN Clinical supervisor, the Case Management Specialist is responsible for overseeing the inbound faxes and distributing health plan materials from the FTP sites to the designated Teammates.
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Manages the CM notification inbox and distributing cases to nurses
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Responsible for extracting Health Risk Assessments from health plan portals for all LA CARE IPA
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Responsible for distributing CM module task report and PCP outreach report to the Episodic team
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Responsible for opening cases for the Top 3+ ERVs by IPA Report
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Responsible for opening and distributing newly eligible LA CARE DSNP cases to the appropriate case manager
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Responsible for disturbing files retrieved from SFTP site
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Assist with Palliative care report
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Responsible for sending files to the Health Plan via the SFTP site
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Updates Case manager trackers
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Responsible for the Rightfax system and routing the faxes to the correct folder and distributes to TM via email
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Assists with calls from members and coordinating care as needed
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Assist with training new onboarding TMs
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Works as a backup to the Case Management Queue which requires knowledge of all aspects of Care Coordination – setting up appointments, arranging transportation for member, and other related UM tasks
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Accountable for completing trainings provided by MPM and HP
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Informs management of any issue gathered from communication
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Ensure emails are responded to within 24 hours
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Works as a backup to the Lead Case Management coordinator
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Works as a Case Management Coordinator Float to assist with coverage when needed
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Accountable for attending all mandatory team huddles and meetings
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Participates in other assignments as required
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High school graduate or GED equivalent
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Minimum of two years’ experience in a call center environment; health plan or medical group call center experience preferred.
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Computer Proficiency on Microsoft Word, Excel, and PowerPoint
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Data Literacy
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Critical Thinking
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Adaptability