Highmark Health Case Management Coordinator in Pittsburgh, Pennsylvania
JOB SUMMARY (Summarizes the major purpose and primary responsibilities)
The job plays a critical role in the clinical team, acting as the primary support for the clinical staff and as a liaison between all members of the care team. Works in tandem with the case managers and disease managers to help facilitate execution of case and disease management, including not limited to, tracking necessary information for member's case, interacting with the member's provider, enabling nurses to optimize workload, helping to arrange required services for the member, assisting with documentation. This job will collaborate and require frequent communication with other members of the team.
ESSENTIAL RESPONSIBILITIES (Describes the critical tasks, duties and responsibilities of the position.)
Screen care management cases (condition management, disease management, etc.) to ensure information is complete and accurate (e.g. identify phone number if missing) and help prioritize cases for outreach; will triage cases to the appropriate person.
Interact with providers to monitor members discharge status disposition, to confirm member activity, to set up appointments, and other provider related activities. Provide assistance to the case manager in monitoring member outcomes as a result of engagement in care management.
Identify and effectively utilize health plan benefits and local provider / community resources to help meet the needs of members; develop expertise about available community resources in assigned geography and share knowledge across the team.
Assist in report production, data collection and data entry for care plan management; perform process auditing activities to ensure compliance with NCQA standards and other compliance measures.
Research information about members such as clinical history, utilization patterns, benefits, etc., and present information to the case manager and other care team members; help with documentation of member interventions.
Arrange required services for the member; perform other condition and case management support activities as assigned, including member telephonic contact as appropriate per business unit needs.
Act as the liaison among all the members of the care team and promote collaborative teamwork.
Other duties as assigned or requested.
High School Diploma/GED-
Substitutions (Acceptable substitutions in lieu of a degree 1 ½ years’ experience = 1 year college)
Minimum: This section refers to the minimum years and type of applicable experience needed to perform the job. Minimum requirements must be non-comparative, objective, and relevant.
3 - 5 years' performing administrative support functions in an office or field setting for a healthcare organization
Experience utilizing customer service related skills
Preferred: This section refers to additional desired years and type of experience that the hiring manager would prefer, above and beyond the basic requirements of the job.
Experience in a health care related customer service or marketing environment that would demonstrate the ability to positively impact the engagement of members in the Organization's condition and case management program
Basic knowledge of care management processes
KNOWLEDGE, SKILLS & ABILITIES ( List the attributes required to perform the job through demonstrated service, education or training)
Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, designing forms and other office procedures
Ability to take direction, to navigate through multiple systemssimultaneously
Ability to communicate, interact, and work effectively and cooperatively with all levels of staff and management teams
Ability to handle many tasks simultaneously and respond to customers and their issues promptly
Ability to communicate well in person, via phone and via e-mail (verbally and written)
Proficient computer skills, including MS Office products
REQUIRED LICENSURE (Licenses that are required to perform the job)
TRAVEL REQUIREMENT: 0 - 25%
(List % of time traveling)
LANGUAGE REQUIREMENT ( other than English )?
(List primary language)
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
( The physical, mental demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential function of their job. Reasonable accommodations will be made when necessary to enable individuals with disabilities to perform the essential duties of the position, to the extent that they do not cause undue hardship.
An employee in this position works in an office environment. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
Teaches/Trains others regularly -Rarely
Travels regularly from the office to various work sites or from site-to-site -Rarely
Works primarily out-of-the office selling products/services (Sales employees) -Does Not Apply
Physical Work Site Required - No
Most On-The-Road Positions
An employee in this position may work in a home or company office environment but is also frequently driving to and from various locations to perform the work off-site. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
An employee in this position is frequently required to move throughout the workplace, sit, stand and walk, use hands and fingers to hold objects, tools or controls, possess fine motor skills (e.g., to write and operate a computer or to steer transportation equipment), possess gross motor skills (e.g., to carry items), reach with hands and arms, climb stairs and ladders, balance, stoop, kneel crouch and crawl, communicate effectively, and talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. The employee must be able to work in a busy environment where decisions often must be made quickly, must attend work on a regular and reliable basis, must adhere to all workplace policies, and may be called upon to work outside regular business hours. This work occurs in a [example: warehouse, hospital or provider’s office or mail room].
Lifting: up to 10 pounds- Rarely
Lifting: 10 to 25 pounds- Rarely
Lifting: 25 to 50 pounds- Rarely
Changes Approved By:
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity