[Hiring] Care Management Associate @Iconma Portal

Role Description

Our client, a Retail Pharmacy company, is looking for a Care Management Associate for their Jefferson County, KY location.

• Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment.
• Manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.
• Support comprehensive coordination of medical services including Care Team intake, screening, and supporting the implementation of care plans to promote effective utilization of healthcare services.
• Promote/support quality effectiveness of Healthcare Services.

Fundamental Components:

• Responsible for initial review and triage of Care Team tasks.
• Identify principle reason for admission, facility, and member product to correctly apply intervention assessment tools.
• Screen patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services in accordance with the benefit plan.
• Monitor non-targeted cases for entry of appropriate discharge date and disposition.
• Identify and refer outlier cases (e.g., Length of Stay) to clinical staff.
• Identify triggers for referral into Client Case Management, Disease Management, Mixed Services, and other Specialty Programs.
• Utilize Client systems to build, research, and enter member information, as needed.
• Support the Development and Implementation of Care Plans.
• Coordinate and arrange for health care service delivery under the direction of nurse or medical director.
• Promote communication, both internally and externally to enhance effectiveness of medical management services.
• Perform non-medical research pertinent to the establishment, maintenance, and closure of open cases.
• Provide support services to team members by answering telephone calls, taking messages, researching information, and assisting in solving problems.
• Adhere to Compliance with PM Policies and Regulatory Standards.
• Maintain accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Protect the confidentiality of member information and adhere to company policies regarding confidentiality.
• May assist in the research and resolution of claims payment issues.
• Support the administration of the hospital care, case management, and quality management processes in compliance with various laws and regulations.

Technical and Logistical Requirements:

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to log in to secure systems, lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.
• Determines medical necessity/appropriateness.
• Facilitates optimal outcomes.
• Identifies and follows through with continuous quality/compliance opportunities.
• May also include identification of aberrances and initiation of corrective action.
• Educates/empowers customers to ensure compliance, satisfaction, and promote patient advocacy.
• Optimize total costs.
• Implementation and evaluation of policy based on usage and program directives.
• Educate/empower colleagues at all levels to enable decision making at the most appropriate level.

Qualifications

• Minimum 3 years of relevant experience.
• Experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavior Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations.
• 2-4 years’ experience as a medical assistant or office assistant.
• Computer literacy and demonstrated proficiency in navigating internal/external computer systems and MS Office Suite applications, including Word and Excel.
• Effective communication, telephonic, and organization skills.
• Familiarity with basic medical terminology and concepts used in care management.
• Strong customer service skills to coordinate service delivery.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.
• High School Diploma or G.E.D.

Benefits

• Health Benefits.
• Referral Program.
• Excellent growth and advancement opportunities.