[Hiring] Medical Management Specialist @Professional Management Enterprises

Role Description

BKG is seeking a Medical Management Specialist (Non-Clinical) to join our team, who will be responsible for executing case management activities, including:

• Telephonic member screening of needs
• Care planning
• Care plan implementation
• Service coordination
• Monitoring and follow-up
• Reassessment
• Case conferencing
• Crisis intervention
• Case closure

Provide NON-CLINICAL support to the medical management or operations area. Review case records and gather clinical data to determine the proper department or area to assign the case. This resource’s primary role will be to:

• Receive inbound member case management calls
• Triage member needs via screening
• Provide appropriate community and other resources to the member
• Make appropriate member referrals to clinical case managers
• Return voicemail calls received on the case management line

Will be referred to as MMS through WO.

Qualifications

• High School Diploma or equivalent required
• Minimum of 1 year of relevant experience in managed care, Medicaid/Medicare, or a related field preferred
• Strong organizational and communication skills
• Strong computer skills are a must

Requirements

• Monitor and manage case management inbound phone queue including return of voicemails, triaging member needs via screening, and assisting member with non-clinical support needs
• Gathers information regarding member or case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review)
• Provides information to members regarding in-network providers or general program information, when requested
• Provides resources to member, as appropriate
• May assist with complex cases
• May act as liaison between Case Management and other internal departments
• Maintains and updates tracking databases, as indicated
• Prepares reports and documents all actions, as indicated
• Responsibilities exclude conducting any utilization management review activities or any other clinical role which require interpretation of clinical information

Benefits

• Hourly Rate: $19.00
• Work Schedule: Full-time remote M-F 8am-5pm
• Must reside within 50 miles of Indianapolis