Care Management Representative, Care Management, Full Time, Days

Inspire health. Serve with compassion. Be the difference.

Job Summary Functions as a core team member of the care team pod, completing administrative and other programmatic supportive tasks vital to the clinical care coordination programs. Serves as non-clinical support to Care Managers and Health Coaches, with flexibility to serve the extended care coordination team pods, based on the care needs of patients/members for the shared population. Plays a key role in initial engagement with members, acting as a central intake resource, obtaining members agreement to participate in the program, scheduling of assessments, assisting in care plan activities created by the Care Mangers and Health Coaches, and monitoring activities for members who meet defined monitoring criteria after management cases have been closed by Care Managers and Health Coaches. Promotes proactive coordination of services to other programs and supports members receiving care from community services.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference

• Conducts telephonic outreach to members to engage and enroll members into the care management programs.

• Takes inbound calls from members seeking to enroll, provides inbound backup for CM calls, and responsible for outbound calls to appropriate patients.

• Manages all mailings and outreach correspondence to members and provides enrolment status, opt-out and inability to reach correspondence to providers.

• Supports scheduling of all appointments for Care Managers follow up.

• Contacts PCP/Specialist to inform them of attributed member enrollment in complex care program and any additional program/services.

• Organize and establish community services as needed and appropriate by the member and Care Manager.

• Monitors closed cases steered from complex care management based on defined monitoring criteria.

• Performs other duties as assigned.

Supervisory/Management Responsibility

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - Associate degree in Nursing, Social Work, or healthcare related field of study. Bachelor's degree in healthcare related field preferred.

• Experience - Two (2) years of strong customer service experience handling confidential health information. Health system experience and experience with EMR (electronic medial records) preferred.

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• NA

Work Shift Day (United States of America)

Location Richland

Facility Value-Based Care and Network Services

Department Ambulatory Care Management

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.