Care Manager Telephonic Nurse Assistant 3

Profile

Description

The Care Manager, Telephonic Nurse Assistant 3, in a telephonic environment, assess and evaluates beneficiary needs and requirements to achieve and/or maintain an optimal wellness state by guiding beneficiaries and their families toward and facilitating interaction with resources appropriate for their care and well-being. The Care Manager, Telephonic Nurse Assistant 3 performs advanced administrative/operational customer support duties that require independent initiative and judgment.

Responsibilities

Perform in a support role providing clerical/administrative, and telephonic duties for medical / behavioral case management team(s). Functions include: Researching / locating providers as needed; assisting with provider identification for beneficiary access to care; creation/ data entry of new cases into the care management system; providing telephonic support of the department by triaging and distributing calls appropriately; facilitating outbound calls for concurrent review/hospital admissions; creating referrals/authorizations and indexing documents as needed; providing support for Warrior Navigation and Assistance (WNAP) line as needed. Adhere to call standards and guidelines; assist Case Management clinicians in establishing appointments for beneficiary engagement as needed; assist in locating and arranging beneficiary provider appointments if needed. Provide support by pulling specified reports, assisting with data input/monitoring for operational objectives.

Our Department of Defense Contract requires U.S. citizenship for this position .

KEY ACCOUNTABILITIES

40% Assists case managers with beneficiary related concerns to include claims or billing inquiries, sending education materials, community resources, enrollment questions, travel attestations and other non-clinical beneficiary concerns. Interface with providers on claims / billing concerns and follow issues through to resolution. Discuss details of problems with the assigned Case Managers as needed. Review/update beneficiary letters and contact information; maintain operational knowledge of all systems that support the CM team to include, but not limited to MSR, Care Management Platform, TIP, DEERS eligibility checks, Patient Finder, claims/WRIKE system, telephone system (contact handling system). Interactive reporting. Communicates effectively with all disciplines of the medical and beneficiary community.

40% Engage in outgoing telephonic communications in order to facilitate provider search inquiries, confirm beneficiary access to care standards; assist with scheduling appointments when necessary; request medical records to support continued stay reviews; document calls in Care Management System /MSR per clinical policy and protocols. Enter appropriate information into the Care Management applications and other required systems.

10% Perform administrative tasks such as assisting with development of meeting agenda, slide development, schedule meetings, care conferences, facilitate webinars, scribe/distribute meeting minutes, and other duties as assigned. Capture data related to inbound calls, assist with special project / contingency plan callouts as needed; Provide coverage for WNAP line during absences or increased call volumes; assist with referral / auth workload during contingencies or times of increased workload.

10% Assist manager and supervisors as needed.

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives .

Required Qualifications

High school diploma

One or more years of experience in handling high volume customer contacts in a courteous and professional manner

Above average written and verbal skills, including organizational abilities.

Ability to handle multiple tasks simultaneously and to prioritize appropriately

Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook

Knowledge and use of medical terminology

Our Department of Defense Contract requires U.S. citizenship for this position

Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Preferred Qualifications

Associates or Bachelor's degree

Two to four years administrative assistant experience

Prior experience with Medical/Behavioral Health Case Management Programs

Experience in health care environment

Military Health Care service experience or working knowledge of TRICARE program

Bilingual a plus

Additional Information

Work Days/Hours : Monday - Friday; must be able to work an 8 hour shift sometime between the hours of 8:00 a.m. - 6 p.m. EST.

Training/Training Hours : Mandatory for the first 4 weeks; 8:00 a.m. - 5:00 p.m. EST

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com