Sr Care Management Assistant

• Reviews and processes case and condition management referrals from Customer Segment task lists per guidelines.

• Review task note and members’ discharge status to prioritize work schedule.

• Check members’ eligibility and demographic information.

• Outreach call to members following Case Management guidelines

• Appropriate and thorough documentation of referral and calls in medical management system utilizing standard documentation
• Introduce case management program and upon acceptance, schedule appointment at members’ convenience or warm transfer to a registered nurse case manager.
• Any immediate need or crisis identified is transferred to clinical designee (Sr. CMA MUST REMAIN ON LINE TO ANNOUNCE CALL)
• If call is unsuccessful, Sr. CMA follows the appropriate failure to contact process and generates letter
• If appointment is scheduled,Sr. CMA will add appointment time to case manager’s outlook calendar and generates a task per guidelines.
• If warm transfer,. Sr. CMA transfers member to case manager and generates a task per guidelines.
• When unable to reach member, or member declines, document in medical management system as per guidelines.
• Documentation is in compliance with NCQA guidelines

• Develop tickler list for next business day, which includes any unfinished tasks.

• Complete weekly and monthly stats.

• Functions as Preceptor to new Care Management Assistants

• Retrieves and processes voice mails and external case management referrals per guidelines.

• Other duties as assigned

Education and Experience:

• High school diploma, degree preferred.
• Computer skills required.
• Prior experience as CMA or Precertification Specialist position preferred.
• The incumbent must be able to learn quickly, think logically, possess a problem-solving aptitude and understand the relationship between the IBC Family of Companies and Managed Care Programs.
• Attention to detail and accuracy is crucial.
• This position requires excellent customer services skills including an understanding of medical terminology in order to provide the best service to members and case management staff.