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Care Management Associate I

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MetroPlus Health PlanNew York, NY
  • MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care.
  • We believe that Health care is a right, not a privilege.
  • If you have compassion and a collaborative spirit, work with us.
  • You can come to work being proud of what you do every day.
  • MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
  • As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics.
  • For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
  • The Care Management Associate I, under the direction of the Senior Director of Clinical Services, is responsible for the daily activities of the member case intake and processing functions and associated work flow, as well as for performing other duties associated with the coordination of member care as outlined and/or assigned by their Manager.
  • Receive service requests from providers and members via facsimile, provider portal, phone and mail
  • Receive in-coming calls, address the caller’s needs (providers and members) and/or offer clarification on questions or concerns as related to policy & procedure and benefits
  • Strive to provide first-call resolution to all callers
  • Provide superior customer service to all providers and members
  • Verify member eligibility and benefits utilizing the MIS system and/or ePACES.
  • Create and/or complete an authorization shell, generating a reference number.
  • Follow documented process flow and job aids to either process the authorization request to completion or direct request to clinical staff (Nurse or MD) for review.
  • Accurately document and enter data in MIS system pertaining to the services requested, including correct member, provider and clinical information such as service dates, diagnosis codes, service codes
  • Work efficiently and diligently and meet minimal required performance expectations and quality requirements
  • Assist co-workers and other staff as directed.
  • Participate in special projects as requested or required.
  • Participate in on-going training and staff meetings to enhance job knowledge and skills, and to offer ideas towards the enhancement of the department’s processes.
  • Participate in departmental quality improvement activities
  • Perform other duties as assigned.
  • Prior managed care experience with customer service/call center experience preferred
  • Understanding of medical terminology including ICD-10 and CPT-4 codes preferred
  • Skilled in using a computer
  • Ability to research on the Internet

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