Care Management Associate
Core
Coordinate medical services, review eligibility, and manage pre-certification cases for health plans.
Role type
Care Management Associate (utilization management support)
Builds
Medical service coordination and case management workflows
Domain
Health insurance / Utilization management
Deliverable
client delivery
Required skills
Medical terminology, call center operations, eligibility verification, pre-certification processing, non-medical research, documentation compliance, internal system navigation
Preferred skills
Customer service, telephonic communication, organization, critical thinking, Excel, Microsoft Word
Responsibilities
Review eligibility and benefits, open and approve pre-certification cases, evaluate patients using intervention rules, coordinate referrals, communicate service delivery outcomes, maintain regulatory documentation, assist with discharge dates and follow-up referrals
Seniority
Individual Contributor, entry-to-mid level