Case Management Analyst
6 days ago
Workers will be remote but should be located in TN, IL, TX, OK, NM or MT. Please put location on top of resume for the manager to review.
please follow your Client rate card for this role
Job Description
1. Perform Longitudinal Care Management (LCM) outreach and follow up attempts to members, including LCM questionnaire.
2. Build relationships with members to encourage compliance with care plans and to alert the Case Manager quickly when issues arise.
3. Serve as the primary monitor of progress and status of our high risk chronic, but stable members.
4. Inform and educate members on the Longitudinal Care Management Programs, using supplied scripts. Complete records in system by performing data entry. Encourage member usage of our programs, including arranging appointments and additional member services (e.g., transportation). Generate appropriate correspondence and send to member manually, electronically, or telephonically.
5. Conduct check-ins with members to review individual care plan goals.
6. Maintain production requirements based on established department business needs.
7. Provide support to the clinical team by performing the non-clinical functions (as identified by the business process) necessary to generate, manage, and close a case within the platform.
8. Receive, analyze, conduct research and respond to telephone and/or written inquiries. Process information from member or provider to determine needs/wants and ensure customer questions have been addressed. Respond to customer or send to appropriate internal party.
9. Notify help desk of system issues.
10. Perform data entry function to update customer or provider information.
11. Obtain required or missing information via correspondence or telephone.
12. Serve as contact for the various groups regarding claims which involves conducting research, obtaining medical records/letters of medical necessity from TMG, reopen or initiate new cases as needed and refer case to clinicians.
13. Support and maintain communications with various in-house areas regarding groups' concerns, i.e.: Marketing, Provider Affairs, and SSD.
14. Communicate and interact effectively and professionally with co-workers, management, customers, etc.
15. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
16. Maintain complete confidentiality of company business.
17. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
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