Universal American
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Telephonic Care Management Assistant

Job Title
Telephonic Care Management Assistant
Job ID
782181
Begin Date
2/28/14
Duration
Location
Houston,  TX
Other Location
Description
Job Description
The Care Management Assistant/SSC assists the clinical Case Manager in both Utilization and Case Management for the integration and coordination of a members care.
 
Responsibilities:
 Provides telephonic follow up with members for Case Management services to include post hospital discharge and chronic condition management.
 Coordinates with the case management team, and Provider, (when indicated by the Case Manager) to assist in the attainment of members’ goals by:
  1. working with member, physician, other Health care providers and the case manager,
  2. meeting the member’s individual needs based on protocols and referrals;
  3. supporting the member education goals regarding their specific chronic condition based on the Plan of Care;
  4. educating the member how to access the benefits;
  5. assisting in the arrangement of Provider follow‐up appointments;
  6. mailing of approved educational and informational materials;
  7. assisting in the performance of “Welcome Home” calls to members post discharge from
  8. inpatient or other levels of care as directed and supervised by the licensed Case Manager; and supporting the monitoring and evaluation of interventions as set and directed by the clinical Care Manager in the Plan of Care by periodic telephonic contact with members based upon data received pertinent to members chronic conditions or other risk triggers, ie; ED visits, IP acute stay, referral for outpatient cardiac procedure. 
Case Management Assistants/SSC must remain objective in their review and not participate in any way in the delivery of care to the patient and:
  •  comply with all departmental policies and procedures;
  •  participate in departmental and company in‐services as appropriate;
  •  perform other duties as assigned by the Case Manager; and
  •  document as required according to policy and procedure.
  •  Administers tasks as detailed in the member specific Plan of Care, under the direction of the clinical Case Manager.
  •  Complies with Customer Service expectations as applicable to the Department and Health Plan.
  •  Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.
  •  And all other duties assigned by the manager and/or supervisor.
 
Required Skills
  •  Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
  •  Organizational skills with the ability to handle multiple tasks and/or projects at one time
  •  Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company
  •  Analytical and interpretation skills including departmental, utilization, financial and operations data
  •  Decision‐making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization
  •  Creative thinking skills with the ability to ask the needed bigger‐picture questions that lead to process and team improvements
  •  Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
  •  Problem solving skills with the ability to look for root causes and implementable, workable solutions
  •  Interpersonal skills with the ability to work in a fast‐paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs
  •  Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization
 
Required Experience
  •  High school graduate
  •  Healthcare related experience is preferred
  •  Personal computer experience should include working with Microsoft Word, Excel,  PowerPoint and Outlook at the intermediate level at a minimum


Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.
Required Skills

High School Diploma, healthcare, computer experience, Microsoft Word, PowerPoint, Excel, Outlook, telephonic
Openings
1

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