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. The goal is to achieve and maintain an optimal wellness state by guiding members and their families toward relevant resources.

Key responsibilities include:

• Reviewing inbound referrals and correspondence for processing, fulfillment, or resolution using various software systems and resources.
• Screening physicians' orders and documentation to ensure all qualifying medical documentation and required information is included.
• Requesting additional applicable information from referring entities when necessary.
• Performing verification of benefits coverage and eligibility for services according to Health Plan contracts.
• Reviewing referral data against specified medical terms, diagnoses, or procedure codes and following established procedures for approving requests or referring them for further review.
• Providing education to members and providers regarding medical benefits, referral status, and prior authorizations.
• Communicating with patients to confirm demographics and explain service details.
• Coordinating the timely delivery of care and services with providers.
• Maintaining detailed documentation of patient, physician, referral source, and provider interactions and communications.
• Collaborating with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care regarding referred services.
• Maintaining knowledge of applicable CPT, HCPC, ICD-10 codes, and insurance contracts.
• Understanding Medicare/Medicaid criteria and Health Plan policies to ensure referrals meet all requirements and guidelines.
• Preserving the security and confidentiality of patients' personal information.
• Reporting ongoing issues with referring entities or providers that delay service delivery to managers.
• Providing excellent internal and external customer service.

The role requires 1-3 years of experience in Home Health or Infusion Pharmacy, with wound care/Ostomy supplies experience preferred. Microsoft Office technical experience with Word, Outlook, and Excel is preferred. Knowledge of Medicare/Medicaid and commercial insurance is required, as is experience with medical authorizations.

This is a part-time remote position with flexible hours, including weekends and holidays, and requires approximately 20 hours of work per week. Overtime may be required as needed.

The compensation range for this role is $38,000 - $45,800 per year.

Benefits include medical, dental, and vision coverage, a 401(k) retirement savings plan, time off, short-term and long-term disability, life insurance, and more.