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Care Management Associate


Reference Number: KBAZCM27747

Care Management Associate
experience  Not Disclosed
location  Phoenix, AZ (100% Remote)
duration  12.0 Months
salary  Not Disclosed
jobtype  Not Disclosed
Industry  Pharmaceutical
duration  $16.34/hour - $18.34/hour
Job Description


Support comprehensive coordination of medical services including member transitions, screening and supporting the implementation of referrals to promote effective utilization of healthcare services.
Promotes/supports quality effectiveness of Healthcare Services. Create authorizations in QNXT to support continuity of care for member. Screens incoming forms using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan. Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services.
Verifyable High School Diploma or GED Required .

Duties

Utilizes critical thinking and judgment to collaborate and inform the case management/concurrent review process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management/concurrent review tools and resources. Will assist with auth creation, appointment scheduling, and outreach to members, assist with HH issues.

Experience

Case management and discharge planning experience
call center experience
Preferred strong customer service skills
Strong problem-solving and analytical skills
Possess strong computer navigation skills
Comfortable with regular feedback and development
Works well in a team environment
Must have basic medical terminology experience

Position Summary

Enhancement of Medical Appropriateness and Quality of Care:- Using holistic approach consults with utilization management clinicians, hospital discharge planning staff, supervisors, and/or other health programs to overcome barriers to meeting goals and objectives;
Coordinates care with providers as a part of comprehensive and proactive discharge planning.
Identifies and escalates quality of care issues through established channels.
Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Helps member actively and knowledgably participate with their provider in healthcare decision-making.

Note :

High school diploma or GED required, 1-2+ years of call center experience.
Mon-Fri 8-5
Remote with future possibility of onsite
This is remote however they will need to potential come onsite . need to be willing to commute onsite.
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

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