care manager Remote
Job description
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
The Care Coordinator performs telephonic outreach and assessment of identified populations and provides coordination of community resources and support to Members and Providers across service areas. This individual also identifies, facilitates, coordinates and advocates for Member access to services that enhance healthcare access and delivery by assisting in the coordination of safety net services that provide for basic needs such as education, housing, healthcare, legal, transportation and counseling assistance. The Care Coordinator facilitates the acquisition of medications for patients to ensure compliance with medication regimens, influences member engagement rates utilizing Motivational Interviewing skills, and persuades Members to participate in Plan sponsored care management activities. Additionally, this role triages for and collaborates with clinical staff to ensure Members receive appropriate care as well as supports one of the following care management programs: Sunny Start, Transition to Home, Population Health Management or Complex Care Management.
Our Investment in You:
- Full-time remote work
- Competitive salaries
- Excellent benefits
Key Functions/Responsibilities:
- Assesses member needs by conducting interviews and structured assessments using Motivational Interviewing techniques to engage Members and determine non-clinical and social needs and engage them in care management
- Educates members by providing information on how to obtain resources, basic health information and by sending information packets to Members containing health information relative to the Member’s identified conditions
- Maintains current knowledge of community resources for referral and linkage to meet Members’ needs
- Participates in group meetings to ensure policies, procedures, and work flows are up to date and advises on revisions needed
- Facilitates member communication with external partners such as state agencies, community based organizations, clinical vendors, and primary care and specialty practices
- Completes documentation in the medical management information system [CCMS] in a timely manner and in keeping with contractual requirements, internal policy and accreditation standards
- Complies with established metrics for performance, adheres to documentation and work flow standards and utilizes other department specific tracking tools
- Triages cases to clinical staff, other departments, contracted vendors and providers as appropriate
- Participates as assigned in answering calls on the care management 800 line
Program Specific Functions:
Transition to Home (TTH)
- Runs TTH census report admissions with TTH with Match Report and removes program ineligible members
- Creates cases in CCMS and checks for discharge dates in CCMS by referencing the facility census or by contacting the facility
- Telephonically outreaches to select full program members
- Calls short program members to ensure an appointment with the PCP or specialist has been set up within a week of discharge and assists member in making appointments as needed
Sunny Start
- Supports members to access necessary equipment such as breast pumps and infant car seats within members benefit structure
- Facilitates member access to and completion of prenatal and postpartum visits according to best practice guidelines and workflow standards
Qualifications:
Education:
- Associate’s degree in Healthcare, Nursing, and Social Work or a related area or equivalent relevant work experience
Experience:
- 2 years of office experience, specifically in either a high volume data entry office, customer service calls center, or health care office administration department
Preferred/Desirable:
- Knowledge and experience in maternal child health
- Experience with FACETS/CCMS or other healthcare database
- Experience with care coordination or case/care management
- Prior customer service experience
- Bilingual skills, fluency in Spanish
Competencies, Skills, and Attributes:
- Motivational Interviewing skills
- Strong oral and written communication skills
- Ability to effectively collaborate with health care providers and all members of the interdisciplinary team
- Demonstrated strong organizational and time management skills
- Able to work in a fast paced environment and multi task
- Experience with Microsoft Office application, particularly MS Outlook and MS Word and other data entry processing applications
- Knowledge of medical terminology strongly preferred
- Knowledge of community resources strongly preferred
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.
- WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.
Required Skills
Required Experience
