• Member Care Associate

    Job Locations US-NY-Staten Island
    ID 2018-1145
    Category
    Non-Clinical- MLTC
    Type
    Regular Full-Time
  • Overview

    Works in conjunction with Nurse Care Managers to ensure delivery of high quality efficient services to all Extended MLTC members.

    Responsibilities

    • Assists Nurse Care Manager with all administrative aspects of care coordination.
    • Utilizes excellent customer service skills to provide administrative support, information, education, and direction to all MLTC members, providers and outside entities (Nursing Homes, Hospitals, etc).
    • Processes service authorizations as requested Nurse Care Managers, and communicates approvals to servicing providers.
    • Mails and faxes determination letters, authorizations, care plans, service changes, and other correspondence as required to members and providers.
    • Coordinates timely delivery of DME and other items/supplies to members, obtains authorizations from Nurse Care Managers as needed.
    • Assists Nurse Care Managers with coordination of monthly calls and communicates members’ needs to NCM in a timely fashion.
    • Assists members in scheduling necessary medical visits and transportation.
    • Coordinates member services with in-network and out-of-network providers.
    • Documents all administrative activities/interventions in appropriate database (HMA, McKesson).
    • Assists with Maximus warm transfer calls.
    • Assists with all translation needs as needed (members, potential enrollees, Enrollment RNs, pre-enrollment screening, etc.).
    • Assists with scanning, printing, filing, and other administrative tasks as needed.
    • Assists with training of new staff.
    • Performs mandatory on-call duties as needed on weekends, holidays, and after working hours.
    • Participates in special projects or other duties as assigned.
    • All other tasks assigned by the management team.
    • Travels to other Extended’s office locations as needed.

    Qualifications

    • High school diploma or GED required
    • Basic computer skills (Microsoft Word, Excel, etc) required
    • Basic knowledge of CPT codes medical terminology preferred
    • Previous experience in Managed Care industry preferred
    • Good communication and organizational skills.

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