Care Specialist - Emblem Health
New York, NY 10001
About the Job
• Responsible for the execution of the non-clinical aspects of the Care Management process.
• Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations,
request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a
case.
• Work seamlessly with the Care Specialists, Care Managers and Social Workers (and other clinical staff) to ensure everything
that a participant needs to tend to their health is addressed.
• Provide confidential administrative support and assistance to the department and support the department in all aspects of
daily project operations.
• Assist the entire Care Management interdisciplinary team in managing members with Care Management needs.
• Provide telephonic outreach to members that have been identified for care management and ensure members' needs are
supported throughout the duration of member enrollment to the program, by completing screenings with members,
coordinating with Care Manager on members' care plan, making appropriate referrals to the interdisciplinary care team,
coordinating post-acute services on behalf of members, assisting with community resource needs and more.
Principal Accountabilities
• Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and
administrative processes and activities.
• Perform accurate and timely intake and data entry for all Care Management requests and referrals for all lines of
business, upon receipt of inbound requests, via call, fax and web portal, in accordance with departmental policy
and regulatory requirements.
• Perform member telephonic outreach for program enrollment with the goal of retaining members in the Care
Management Program.
• Triage cases and assign receipts to appropriate teams.
• Communicate and/or respond to inquiries from providers, facilities and members.
• Initiate completion of member and provider correspondence and verbal outreach according to departmental
guidelines.
• Enter and maintain documentation in electronic record, meeting defined timeframes and performance standards.
• Provide phone queue management for both incoming and outgoing calls.
• Perform other related projects and duties as assigned.
• Under the direction of a Care Manager, manage caseload and update care plans for low and moderate risk
members in collaboration with the clinical team.
• Support care interventions including making doctor's appointments, health coaching, referrals to internal and
external resources, assist with transportation issues.
• Leverage motivational interviewing skills and a member-centric approach to identify members' needs, prioritize
and support care plan.
• Perform a wide range of research and educational outreach activities to encourage healthy behaviors, such as
outreaching to identified members who need a primary care provider or who may have gaps in care related to
recommended tests or provider visits and facilitate gap closure and receipt of evidence-based care.
• Adhere to processes for collecting member-specific clinical and demographic data from providers and other
entities as required by clinical staff.
• Support communication and coordination with delegated entities, as necessary.
• Coordinate directly with community-based organizations and agencies to identify available and/or alternative
resources for a wide range of concerns, including home safety, financial assistance, caregiver support and
transition assistance.
• Actively participate in assigned committees and projects.
• Additional tasks and duties as required.
Education, Training, Licenses, Certifications
• High School Diploma required.
• Associate Degree or Medical Assistant certification preferred.
• Bachelor's in related field preferred.
Relevant Work Experience, Knowledge, Skills, and Abilities
• At least 1-2 years of previous client-facing or data entry experience in a health care environment. (R)
• Additional years of experience/certifications/training may be considered in lieu of educational requirements. (R)
• Strong oral, written and interpersonal communication skills required. (R)
• Ability to work both independently and collaboratively with others. (R)
• Previous system user experience in a highly electronic environment required. (R)
• Proficiency in Microsoft Office suite skills required. (R)
• Knowledge of medical terminology and medical payment preferred. (P)
• Ability to prioritize multiple tasks. (R)
• Required to work weekends, nights and holiday as necessary. (R)
Additional Information
- Requisition ID: 1000000684
- Hiring Range: $45,000-$55,000