Care Management Specialist

2 days ago

Minneapolis, Minnesota, United States Fairview Health Services Full time
Job Title: Care Management Specialist

Overview

M Fairview Health Services has an exciting opportunity for a Care Management Specialist to join our team at our Edina, MN location.

This is a 1.0 FTE (80 hours per two week pay period) opening with a hybrid work arrangement, offering a great work-life balance. As a Care Management Specialist, you will be responsible for establishing and maintaining relationships with providers, patients, families, and vendors of Fairview Partners, as well as serving as a liaison between Fairview Partners and the health plans for all community enrolled members.

Responsibilities
  • Serve as a liaison to patients, vendors, providers, and health plan representatives to resolve issues related to billing and health plan referral verification.
  • Understand the guidelines and processes within each health plan surrounding claims payment for patient referrals.
  • Assist case managers or providers with utilization, authorization, and claims payment as appropriate and requested.
  • Coordinate and facilitate services as directed by the Care Coordinator.
  • Perform, understand, and explain functions related to the referral process of patients.
  • Approve/Direct patient referrals to appropriate settings.
  • Understand benefit structures of each contracted health plan.
  • Communicate directly with vendors, clinics, and payers or as needed to patients.
  • Responsible for oversight of monthly member reporting.
  • Review health plan member reports for accuracy, which ties to monthly capitation payments from health plans.
  • Work with the health plans and care coordinators to correct discrepancies and appropriately assign members to correct care systems.
  • Utilize Excel and Access database to report new member information to providers and internal entities of Fairview.
  • Coordinate Member Care.
  • Assist the Care Coordinators in coordinating and ordering services for community members.
  • Research community resources for Fairview Partners members and develop relationships with new vendors to utilize their services on an ongoing basis.
  • Document member information using EPIC and the Department of Human Services reporting system.
  • Monitor and process changes to member's health plan status, agency updates, and other internal tracking spreadsheets.
  • Assist members in transportation, appointment, and DME & supply requests.
Qualifications

Required

  • Two-year degree in a healthcare-related field or minimum equivalent work experience of four years in a healthcare setting.
  • Two to four years of recent experience in a healthcare setting.
  • Two to three years of recent experience with Microsoft Word, Excel, and Access.

Preferred

  • Four years of experience in a healthcare setting.
  • Three years of experience with EPIC, Microsoft Word, Excel, and Access.
  • Previous experience with referrals processing in a medical office.

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, sex, gender, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

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