Supports the daily operations of the Virtual Hub by providing select program interventions in accordance with established care management program guidelines for identified at risk members under the direction of a member of the clinical team. Provide administrative to a clinical team responsible for a defined population of members/beneficiaries.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Performs in a call center environment appropriately processing or triaging calls from members, caregivers, providers, internal and external customers
Handles in/outbound calls and transactions directly supporting clinical staff and assigned teams in accordance with metric and performance requirements
Assists in the enrollment of members in a care management program according to established program guidelines
Creates updates, maintains and/or closes tasks as assigned within process guidelines. Routes case to appropriate Care Coordinator based on established guidelines
Collaborates with the members, care givers, physicians, staff, and other health care professionals across the continuum to provide care coordination at the direction of the Care Coordinator include but not limited to: implementing programs interventions, documenting activities, assisting providers in obtaining authorization, making follow up calls and sending out educational materials and letters
Assists members and caregivers with problem resolutions and strategies to reduce barriers to care and increase health care compliance
Identifies problems or gaps in community resources that impact outcomes, care or utilization of services and communicates problems or gaps to the Care Coordinator
Identifies members with Care Gaps/HEDIS related health conditions and assists them in accessing care through scheduling appointments and referral to community resources
Reinforces with members the prescribed treatment plan including attainment of goals and identification of barriers to success
Enters timely and accurate data into Care Management applications necessary to communicate member needs and to ensure complete documentation of member needs and phone calls
Facilitates access to entitlement programs and/or community resources
Adheres to organizational and departmental policies and procedures and credentialed compliance
Demonstrates proficient PC skills in a Windows based environment including word processing, spread sheets and working in database programs
Attends educational offerings to keep current on Information Technology, disease self-management protocols and maintains knowledge of available community resources
Performs all other related duties as assigned by Clinical staff, Supervisor, Manager or Director.
EDUCATION AND EXPERIENCE REQUIREMENTS:
Associate degree in a health care related field required; bachelors degree preferred;
Knowledge of medical terminology
Proficiency working with computers and various computer software applications..
KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:
Strong organization skills
Excellent customer service and interpersonal skills on phone and in-person
Ability to handle multiple tasks simultaneously
Ability to maintains confidentiality of all company, and member information
Post End Date
Nov 1, 2019
EEO Posting Statement
Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.
Christiana Care Health System