Job Description

GENERAL PURPOSE/SCOPE:

The Care Management Coordinator works in conjunction with the Care Management Team to ensure the timely implementation of quality services to Integra’s members.

RESPONSIBILITIES:

• Provide call center coverage as needed and first call resolution
• Coordinates with members, vendors, and providers to ensure timely delivery of quality in-home services that are aligned with members’ service plans
• Ensures services are in place for all newly enrolled members and that services are ended timely & appropriately for dis-enrolling members
• Confirms all documentation is complete, authorizations are received by vendor/provider, and member’s services/supplies are in place
• Develops and maintains effective working relationships with members, families, advocates, service providers, and all members of the care management team
• On an ongoing basis, monitors and ensures the timely execution and delivery of services to members, ensuring there are no lapses in service
• Maintains and updates member records with pertinent information as necessary
• Handles member, vendor, and provider requests for information and member materials
• Obtains MD Orders, prescriptions, forms and all other documentation necessary from members and providers to ensure good quality service
• Procures missing documentation as needed and ensures that all required documentation is present, complete, and accurate in Care Compass
• Mails/Faxes documentation to members and vendors as needed (Care Plan, NOAs, CDPAP forms).
• Completes Member Engagement Questionnaire for new enrollees
• Daily Care Management communication & follow-up
• Fields member and provider telephone calls, responding to inquiries and resolving information requests
• General office duties such as sorting mail, faxing, scanning, filing, updating and printing documents
• Translation support for the Care Team as needed
• All other duties and responsibilities as assigned

Qualifications

QUALIFICATIONS:

• Minimum High School Diploma, Bachelor’s Degree preferred
• Minimum of two years of administrative experience
• Previous experience working with Health Care Insurances
• Knowledge of Health Care Organizations, Home Care and/or Long Term Home Care Agencies
• Knowledge of Medicaid eligibility requirements and MLTC processes and regulatory requirements
• Must possess bilingual verbal language skills in English-Korean

SKILLS:

• Demonstrated ability to organize, problem solve and complete tasks within designated time frames
• Self-starter with a high level of accountability and responsibility
• Excellent written, verbal, and interpersonal communication skills
• Exemplary customer service skills
• Highly organized and able to effectively manage multiple priorities
• Proficient in Microsoft Word & Excel a plus

Additional Information

Integra is an Equal Opportunity Employer and prohibits discrimination or harassment based on any characteristics protected by the laws or regulations in the locations where we operate.

If this opportunity sounds exciting and challenging to you, please click “Apply” now!