Care Management Support Assistant

The Care Management Support Assistant contributes to the administration of care management, providing non-clinical support to assess and evaluate members' needs and requirements to achieve optimal wellness. The role involves reviewing inbound referrals and correspondence, screening physician's orders and documentation, verifying benefits coverage and eligibility, and coordinating care and services with providers.

Responsibilities:

• Review inbound referrals and correspondence for processing, fulfilment, or resolution
• Screen physician's orders and documentation to identify qualifying medical documentation and required information
• Request additional information from referring entities when necessary
• Perform verification of benefits coverage and eligibility for services
• Provide referral management education to members and providers
• Coordinate timely delivery of care and services with providers
• Maintain detailed documentation of patient, physician, referral source, and provider interactions
• Work with various teams, including Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care
• Maintain knowledge of applicable CPT, HCPC, ICD-10 codes, and insurance contracts
• Understand Medicare/Medicaid criteria and Health Plan policies
• Adhere to applicable federal/state regulations and laws related to patient confidentiality and HIPAA

Requirements:

• 1-3 years of Home Health or Infusion Pharmacy experience
• Wound care/Ostomy supplies experience preferred
• Microsoft Office technical experience with Word, Outlook, and Excel preferred
• Knowledge of Medicare/Medicaid and commercial insurance required
• Experienced with medical authorizations required
• Excellent customer service and communication skills

Benefits:

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Time off, including paid time off, company and personal holidays, and paid parental and caregiver leave
• Short-term and long-term disability
• Life insurance