护理管理支持协调员II - LTSS医疗补助服务
Care Management Support Coordinator II - LTSS Medicaid Services
职位职责：支持行政护理管理活动，包括进行外联工作、接听来电并安排服务。作为成员、供应商和员工的联系人，解决相关问题，并根据当前州和监管指南记录成员信息。
关键信息：此职位支持年龄21岁及以上的Medicaid LTSS成员。我们寻找至少有2年在远程呼叫中心环境中进行外联通话给成员或供应商的经验，以及至少2年处理医疗或保险授权并协调成员或供应商服务的经验。
成功的候选人应注重细节、灵活、学习能力强，并且能够熟练使用基于网络的系统和CMS平台。
工作时间：周一至周五，上午8:00至下午5:00或上午8:30至下午5:00（EST）。
- 通过电话与成员进行外联，协助其完成护理计划下一步，提供社区或健康计划资源，解答与排程相关的疑问或关注点，并在整个护理/服务过程中对成员和供应商进行持续教育
- 为成员提供支持，帮助其连接到其他健康计划和社区资源，确保他们获得高质量的客户服务/护理
- 可运用所分配健康计划的活动和资源知识
- 作为成员和/或供应商查询、请求或关注事项的一线支持人员，可能包括解释护理计划流程和协议
- 支持成员入会和日常行政工作，包括发送欢迎信、相关信函和项目教育材料，以促进成功的成员/供应商关系
- 记录和维护非临床成员信息，确保符合州和监管要求的标准和政策，并在需要时提供给供应商
- 了解本地现有福利和资源，并转介以满足社会决定因素健康（SDOH）需求
- 执行其他指派的任务
- 遵守所有政策和标准
教育/经验：需要高中文凭或同等学历
需要1-2年相关经验
优先考虑的经验：
- 至少2年支持21岁及以上接受长期服务和支持（LTSS）的成年人的经验
- 至少2年在完全外呼呼叫环境中的成员或供应商外联经验
- 至少2年处理医疗/保险授权的经验
查看英文原文
Position Purpose: Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines.
Key Details: This role supports Medicaid LTSS members who are age 21 and older. We are looking for candidates with at least 2 years of experience making outbound calls to members or providers in a remote call center environment, along with 2 years of experience processing healthcare or insurance authorizations and coordinating services for members or providers.
Successful candidates are detail-oriented, flexible, quick learners, and comfortable using web-based systems and CMS platforms.
Work Schedule: Monday–Friday, 8:00 AM–5:00 PM or 8:30 AM–5:00 PM (EST).
- Provides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service
- Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service
- May apply working knowledge of assigned health plan(s) activities and resources
- Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols
- Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship
- Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed
- Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health (SDOH) needs
- Performs other duties as assigned
- Comply with all policies and standards
Education/Experience: Requires a High School diploma or GED
Requires 1 – 2 years of related experience
Preferred Experience:
- 2+ years supporting adults age 21+ receiving Long-Term Services and Supports (LTSS)
- 2+ years of member or provider outreach in a fully outbound call environment
- 2+ years processing healthcare/insurance authorizations and coordinating member or provider services
Pay Range: $17.84 - $28.02 per hour
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Originally posted on Himalayas