Case Management Associate – Maternity

This is a fully remote position, open to applicants in California, +2 more states.

📋 Description

• Support the Case Management department by assisting with the administration of CM functions, including telephonic outreach to members.

• Monitor member eligibility and ensure that database information is current.

• Investigate support services available for families.

• Collaborate with Case Managers to foster open communication with members.

• Assist and guide callers to the appropriate staff member in a friendly, helpful, and courteous manner, following customer service best practices.

• Verify member eligibility in accordance with ProgenyHealth policies, procedures, and workflows.

• Perform daily outreach and follow-up calls to members and providers as instructed by CM Leadership.

• Facilitate the transfer of members to a Case Manager or Care Coordinator for assessment completion, or arrange an appointment for the member to speak with them later.

• Record member and provider details, as well as calls, in the medical management database as necessary.

• Complete scripted introduction calls to provider offices.

• Redirect clinical inquiries from members or providers to the Nurse Case Manager.

• Guide members to the appropriate client contact for complaint calls, documenting the information received and notifying the Supervisor.

• Attend and contribute to meetings focused on Quality Improvement updates and concerns.

• Ensure the confidentiality of member information and comply with company policies regarding confidentiality and PHI disclosure.

⛳️ Requirements

• Candidates must reside in one of the following time zones: CST/MST and/or PST.

• 1 – 3 years of customer service experience in a healthcare setting is required.

• Bilingual (Spanish speaking) candidates are preferred.

• A high school diploma or equivalent is mandatory.

• A college degree is preferred.

• Strong preference for candidates with call center (outbound) experience.

• Experience in the insurance/payor field is preferred.

• Excellent verbal and written communication skills, with the ability to clearly express thoughts and interact professionally with members, clients, and staff across all departments within and outside the organization.

• Strong problem-solving abilities, with a focus on identifying root causes and implementing effective solutions.

• Proficiency at an intermediate to advanced level in Outlook, Excel, PowerPoint, and Word is required.

• Must be self-motivated and eager to learn various tasks.

• Strong organizational skills with the ability to prioritize tasks effectively.

• A commitment to excellence in customer service is essential.

🏝️ Benefits

• 401K with company matching

• Medical and dental insurance

• Long Term Disability coverage

• Paid Time Off