Care Management Associate
Core
Support Utilization Management and Care Management operations by completing non-clinical activities to move member cases through review accurately and timely.
Role type
Care Management Associate (non-clinical operations)
Builds
Case processing workflows for health insurance members
Domain
Health insurance / Utilization Management
Required skills
case triage, data validation, provider outreach, documentation, workflow adherence, productivity management, HIPAA compliance
Preferred skills
Utilization Management experience, prior authorization knowledge, MedCompass platform familiarity, medical billing/coding (ICD-10/CPT), regulatory familiarity (NCQA/URAC)
Technologies
MedCompass, provider portals, case management systems
Responsibilities
Review and triage utilization management work; research and validate member/provider/facility information; conduct outbound outreach to providers; document case activity and outcomes; route cases to clinical staff; monitor work for missing information; manage assigned work within turnaround times; protect PHI/PII and comply with HIPAA
Seniority
Individual Contributor, entry-to-mid level