Care Management Support Specialist

📋 Description

• Oversees Care Management programming by leveraging various systems and tools to enhance member engagement and enrollment across Care Management, Quality, and Community Health services.

• Acts as a liaison among members, Care Management teams, and external vendor partners to ensure timely transitions, follow-ups, and issue resolution.

• Facilitates efficient and effective digital and telephonic engagement processes, including referral routing, outreach coordination, task management, and documentation follow-ups.

• Proactively identifies operational challenges, access barriers, or workflow deficiencies that may affect member experience or program performance, escalating issues to relevant clinical or leadership teams.

• Provides daily operational support for Care Management programs, ensuring that workflows are organized, efficient, and consistently implemented.

• Maintains and revises standard operating procedures (SOPs), job aids, trackers, and workflow documentation to sustain consistency, quality, and audit readiness.

• Compiles and sustains operational reports, dashboards, and tracking tools related to referrals, outreach efforts, timeliness, and program effectiveness.

• Aids in accreditation and regulatory compliance by preserving necessary documentation, evidence logs, and trackers in collaboration with designated accreditation leads (URAC, NCQA, and relevant state and federal regulations).

• Functions as a super-user of the care management platform, supporting testing, upgrades, enhancements, and surveys; documents issues and coordinates solutions with IT and business partners.

• Collaborates with internal subject matter experts to facilitate program launches, enhancements, and continuous improvement initiatives as business requirements evolve.

• Upholds the confidentiality of all regulated information in accordance with state and federal laws, including PHI and PII, while adhering to all corporate, divisional, and departmental policies and procedures.

• Achieves established individual and program performance standards, encompassing productivity, quality, and service expectations.

• Independently manages workload, juggling multiple priorities concurrently, and operates with minimal supervision.

• Performs additional duties as assigned.

⛳️ Requirements

• Associate degree in business administration, healthcare management, or a related discipline, or an equivalent combination of education and experience in healthcare operations, care coordination, health insurance, or a comparable support role.

• 1–3 years of relevant professional experience in healthcare operations, care coordination, health insurance, or a similar support role.

• Experience in navigating multiple systems and tools to assist members and internal teams across various communication channels.

• Familiarity with health insurance concepts, benefits, and healthcare navigation.

• Strong organizational, communication, and problem-solving capabilities.

• Proficient in Microsoft Office applications.

🏝️ Benefits

• Highly competitive total rewards package, including comprehensive medical, dental, and vision benefits, alongside a 401(k) plan with contributions from both employee and employer.

• Annual incentive bonus plan contingent on company achievement of goals.

• Paid time away from work, including holidays, paid time off, and volunteer time off.

• Opportunities for professional development, mentorship, and a tuition reimbursement program.

• Paid parental leave and adoption leave, including financial assistance for adoption.

• Employee discount program.