Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Care Specialist

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Administrative & Support
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210JH Requisition #
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Responsible for the execution of the non-clinical aspects of the Utilization Management process. Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations, request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a case. Work seamlessly with other interdisciplinary teams to ensure members’ needs are met. Provide confidential administrative support and assistance to the department in all aspects of daily program operations.

 

Responsibilities

  • Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities.
  • Perform accurate and timely intake and data entry for all UM authorization requests and referrals for all lines of business, upon receipt of inbound utilization management requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements.  
  • Triage cases and assign receipts to appropriate teams.
  • Respond to inquiries from providers, facilities and members. 
  • Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
  • Enter and maintain documentation in the medical management workflow tool, meeting defined timeframes and performance standards.
  • Provide phone management for both incoming and outgoing calls.
  • Communicate with members and providers as required.
  • Perform other related projects and duties as assigned.
  • Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
  • Support communication and coordination with delegated entities, as necessary.
  • Actively participate in assigned committees and projects.


 

Qualifications

  • High School Diploma required
  • Associates degree or Bachelor’s degree in related field preferred
  • At least 1-2 years of previous client-facing or data entry experience in a health care environment.
  • Additional years of experience/certifications/training may be considered in lieu of educational requirements.
  • Strong oral, written and interpersonal communication skills required.
  • Ability to work both independently and collaboratively with others.
  • Previous system user experience in a highly electronic environment required.
  • Proficiency in Microsoft Office suite skills required.
  • Knowledge of medical terminology and medical payment preferred.
  • Ability to prioritize multiple tasks.
  • Required to work weekends and holiday as necessary.

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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