Care Management Support Assistant – Part Time

This is a fully remote position, open to applicants in Florida.

📋 Description

• Assess incoming referrals and correspondence for processing, fulfillment, or resolution.

• Evaluate physician orders and documentation for necessary medical information.

• Obtain additional information from referring entities when required.

• Confirm benefits coverage and eligibility for services.

• Analyze referral data against medical terms, diagnoses, and procedure codes.

• Approve requests or escalate them for further review based on established protocols.

• Deliver referral management education to both members and providers.

• Interact with patients to verify demographics and clarify requested services and care.

• Ensure the timely coordination of care and services with providers.

• Convey final referral decisions to referring entities, providers, and members.

• Keep thorough documentation of interactions involving patients, physicians, referral sources, providers, and communications.

• Work collaboratively with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care teams.

• Uphold patient information security and confidentiality.

• Notify the manager regarding any issues that may delay service delivery.

• Provide exceptional internal and external customer service while adhering to quality standards.

⛳️ Requirements

• 1-3 years of experience in Home Health or Infusion Pharmacy is required.

• Experience with wound care/Ostomy supplies is preferred.

• Proficiency in Microsoft Office, particularly Word, Outlook, and Excel, is preferred.

• Knowledge of Medicare/Medicaid and commercial insurance is required.

• Experience with medical authorizations is necessary.

• Familiarity with medical billing is preferred.

• Strong customer service and communication skills are essential.

• Completion of Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse is required.

• Knowledge of applicable CPT, HCPC, and ICD-10 codes is necessary.

• Understanding of insurance contracts, Medicare/Medicaid criteria, and Health Plan policies is required.

• Awareness of relevant federal/state regulations, patient confidentiality, release of information, and HIPAA is essential.

🏝️ Benefits

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Comprehensive benefits package supporting health and financial well-being.

• Flexible overtime as required.