Care Worker

Job Summary

Facilitates department workflow by supporting clinical team with various care coordination workflows. Locates community services and other referral locations for enrollees, arranges access to care, supports communication with hospitals, and providers.

Essential Functions

• Provides non-clinical support to workflows involving utilization management, case management, disease management, and health promotion.
• Trouble shoots when an appropriate provider, type of service, or appropriate level of care cannot be readily found.
• Has current knowledge or researches availability of community resources and services and link members to appropriate services. May assist in transitions in care for hospitalized patients and makes appropriate placements, if needed.

• Assumes responsibility for self-development and career progression.
• Proactively seeks and participates in ongoing training (formal and informal) in all aspects of the Care Worker role.
• Assists in the mentoring and training of new Care Workers.
• Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.

• Coordinates and manages distribution of correspondence and materials to enrollees and providers.
• Participates in operational activities, including data collection, tracking, and analysis.
• Experience in a managed care environment, integrated medical and behavioral health care and/or training in chronic pain management.
• Understanding of plan benefit structures, psychiatric/medical terminology, and local communication resources.

Qualifications

• Associate’s Degree required / Bachelor's Degree preferred.
• 1 years’ experience in a managed care environment preferred.
• Computer skills are a must and have to be able to MICROSOFT OFFICE (Specifically WORD, EXCEL & OUTLOOK)- proficient with type proficiently.

Additional Information

All your information will be kept confidential according to EEO guidelines.