Care Management Associate I

Care Management Associate I

Job Ref : 129229

Category : Utilization Review and Case Management

Department : UTILIZATION MANAGEMENT

Location : 50 Water Street, 7th Floor,

New York,

NY 10004

Job Type : Regular

Employment Type : Full-Time

Salary Range : $50,000.00 - $51,625.00

Empower. Unite. Care.

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.

About NYC Health + Hospitals

MetroPlus Health 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 Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlus Health has been committed to building strong relationships with its members and providers.

Position Overview

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.

The Care Management Associate I (CMA), under the direction of the Vice President of Clinical Services, is responsible for the daily activities of member case intake, processing functions, and associated workflow, as well as for performing other duties associated with the coordination of member care as outlined and / or assigned by their manager.

Duties & Responsibilities

• 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 IT 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 :

Initiate requests via phone / facsimile for supporting documentation to determine medical necessity of requested services

Minimum Qualifications

Benefits

Professional Competencies

NYC Health and Hospitals offers a competitive benefits package that includes :

#LI-REMOTE

#MPH-50