IR
Case Management Processor
Integrated Resources, Inc
- 🇺🇸 United States
- Remote
- 4 days ago
- triage
- Risk Management
- medical terminology
- Windows
- HIPAA
- Health insurance
4 days ago
Will the position be 100% remote? Yes
Are there any specific location requirements? Must reside in WA (outside Greater Seattle)
Are there are time zone requirements? Member outreach will be in Pacific time, 8 a.m – 5 p.m.
What are the must have requirements?
Excellent communication/customer relation skills; attention to detail; proficiency in documentation; proficient in technology/computer skills
What are the day to day responsibilities
Outbound calls to Medicaid members to identify medical/BH/Social Determinants of health needs followed by referral/assignment to appropriate team
Is there specific licensure is required in order to qualify for the role? No
What is the desired work hours (i.e. 8am – 5pm) 8-5, Monday through Friday
Duties and Responsibilities
Provides support to the Case Management staff performing non clinical activities and supporting the management of the department.
Responsible for initial review and triage of Case Management tasks.
Reviews data to identify principle member needs and works under the direction of the Case Manager to implement care plan.
Screens members using Client policies and processes assisting clinical Case Management staff as they identify appropriate medical services
Coordinates required services in accordance with member benefit plan.
Promotes communication, both internally and externally to enhance effectiveness of case management services (e.g., health care providers and health care team members).
Runs reports to assist in coordination of case management needs.
Provides support services to case management team members by answering telephone calls, taking messages and researching information.
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Protects the confidentiality of member information and adheres to company
Knowledge, Skills and Abilities
Strong customer service skills to coordinate service delivery including attention to members/customers, sensitivity to concerns, proactive identification and resolution of issues to promote positive outcomes for members
Demonstrated ability to communicate, problem solve, and work effectively with people
Working knowledge of medical terminology and abbreviations
Ability to think analytically and to problem solve.
Good interpersonal/team skills
Must have a high regard for confidential information
Ability to work in a fast paced environment
Able to work independently and as part of a team.
PC experience in Windows environment and accurate data entry at 40 WPM minimum.
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members,
providers and customers
Required Education:
High School Diploma or G.E.D.
Required Experience:
Two or more years experience as a medical assistant, office assistant or other healthcare service administrative support role.
Case Management Processor · Integrated Resources, Inc