Care Management Support Assistant

# Become a part of our caring community
The Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Management Support Assistant performs basic administrative/clerical/operational/customer support/computational tasks. Typical works on routine and patterned assignments.

The Care Management Support Assistant will review inbound referrals and correspondence for processing, fulfilment or resolution utilizing all appropriate software systems and resources. Screen physician’s orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity. Perform verification of benefits coverage and eligibility for services per Health Plan contract.

Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for approving request or referring request for further review. Provide referral management education to members and providers regarding medical benefits, referral status and prior authorizations. Communicate with patient to confirm demographics and explain the details of the services/care requested. Coordinate the timely delivery of care and services with providers.

Also communicate with referring entities, providers, and members regarding final referral determination while maintaining detailed documentation to record patient, physician, referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care regarding referred services. Maintain working knowledge of applicable CPT, HCPC, ICD-10 codes, and all insurance contracts. Understand Medicare/Medicaid criteria and Health Plan policies to ensure the referral meets all requirements and guidelines.

Maintain knowledgeable of, and adhere to applicable federal/state regulations, laws related to patient confidentiality, release of information, and HIPAA. Always preserve the security and confidentiality of patients’ personal information. Report ongoing issues with referring entities or providers that delay service delivery to manager. Provides excellent internal and external customer service by ensuring work meets quality standard.

Required Qualifications

• 1-3 years of Home Health, or Infusion Pharmacy experience is required.
• Wound care/Ostomy supplies experience is preferred.
• Microsoft Office technical experience with Word, Outlook, and Excel is preferred.
• Knowledge of Medicare/Medicaid & commercial insurance is required.
• Experienced with medical authorizations is required.
• Knowledge of medical billing is preferred.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Excellent customer service and communication skills.

Additional Information

• Remote (Subject to potential future adjustments based on evolving business requirements)
• Overtime:
  As needed

Work at Home Requirements:
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient…