[Hiring] Care Management Support Specialist @Careforth

Role Description

Reporting to the Manager, Care Management, the Care Manager Support Specialist (CMSS) is responsible for a wide array of administrative and operational activities to support care management team(s). The CMSS will assist the Manager and care teams with care coordination, community resource referrals, internal audits, and ongoing compliance with credentialing and state requirements. In addition, the CMSS will help to ensure timely communication with internal/external stakeholders in support of the delivery of care management service delivery.

What You Will Do

• Assist the Care Management team with internal and external communication, including making referrals for community resources as requested by the care team.
• Assist the team with caregiver credentialing and caregiver expirables that are required per regulation.
• Assist with tracking authorizations for continued service delivery.
• Review denied and ineligible reports from the medical billing team; work with appropriate stakeholders to assist with claim resolution and update systems of record where applicable.
• Monitor and manage emails and phone calls related to the Structured Family Caregiving and Shared Living programs; follow-up with care team members and provide documentation to relevant parties as needed.
• Run routine reports within Salesforce (e.g. compliance tasks, census, open incidents, IOS, etc.) and provide updates to care teams and managers as needed.
• Utilize dashboards and reports within the case management system to drive efficient outcomes and understand trends (e.g. obtaining timely authorizations, managing referrals, branch timeliness).
• Assist with compliance audits, both internal and external.
• Assist with caregiver and team technology-related issues as they arise.
• Occasional travel to a caregiver’s home may be required.
• Perform other projects and duties as assigned.

Qualifications

• 2-4 years of experience in an operations or administrative role, preferably in a case management or healthcare setting.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook).
• Strong communication skills, excels in professional interactions by phone and writing.
• Strong attention to detail and experience with data integrity in a regulated environment.
• Strong business acumen with desire to understand end to end business operations.

Benefits

• Flexible schedules.
• Remote-first culture.
• Nationally recognized wellness program.
• Designed to help you thrive, both professionally and personally.

Company Description

Founded in Boston, Careforth's caregiver programs and services improve health outcomes, keeping care at home longer. Additionally, our programs provide financial benefit to caregivers and cost savings to state agencies and health plans. At Careforth, we understand the challenges of caregiving and are committed to supporting family caregivers at every turn.