Case Specialist - HCMS Job

Case Specialist - HCMS Job

Case Specialist - HCMS

Job ID: 2012-17750
# Positions: 1
Location: US-NY-New York
Search Category: Health Care Operations
Type: Regular Full-Time (30 hours)
Posted Date: 1/26/2012

More information about this job:
Summary:

The Case Specialist - Plan is responsible for managing care and services to members. Case Specialists works in conjunction with Case Managers to coordinate health care services by facilitating, scheduling, and arranging a variety of treatment and health care plans.

Responsibilities:

1. Coordination, authorization, fulfillment, monitoring and tracking of health care services.

2. Establish working relationships with referral sources

3. Initiates and maintains contact with assigned individuals/significant others and providers to determine members response to services.

4. Coordinate home visits for Case Managers.

5. Review of benefit systems.

6. Identifies cases in consultation with Case Manager that would benefit from alternative care.

7. Coordinates assignments for Case Managers to facilitate timely member evaluation.

8. Arranges for services as identified by the case manager such as home health resources, alternative long-term care placements etc.

9. Knowledge of care-coordination and case management concepts.

10. Identifies potential liability issues for services provided.

11. Utilizes knowledge of community resources.

12. Refers members to case management as indicated.

13. Ensures that health care services are received as authorized by the provider.

14. Collaboratively works with other departments.

15. Utilizes excellent customer service principles to assist internal and external customers.

16. Maintains member confidentiality.

17. Other duties as requested or assigned.

Qualifications:

Education

Required:

Associate Degree required (or equivalent experience)

Preferred:

Bachelors degree preferred

Medical Terminology preferred

Years and Type of Experience Required:

Required:

Minimum of (2) years working in Health Services field

Bilingual an asset.

Other

Required:

Computer literate

Excellent verbal and written communication skills.

Strong decision making skills.

Ability to provide services in an environment that involves multiple health care systems.

Ability to interact with all relevant components of the health care system.

Ability to provide services that deal with the individuals broad spectrum of needs

High energy level.

Self-starter with ability to handle multiple projects at one time.

Appreciation of cultural diversity and sensitivity towards target population.

Bilingual a plus.

PHYSICAL REQUIREMENTS:

Must be able to operate a computer.

Must be able to operate a telephone

ermHO