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.

Sr. Care Specialist

📁
Administrative & Support
📅
200RX Requisition #
Sign Up for Job Alerts

Responsible for the execution of the non-clinical aspects of the Utilization Management and/or Case Management process:  ensure that information is appropriately configured in the system to effectively execute member care plans; troubleshoot system issues related to established care plans/authorizations; originate authorizations; request clinical information, case research and preparation/documentation as necessary; order service; handle participant inquiries, and essentially execute all of the “mechanics” behind the scenes. Work seamlessly with the Care Specialists and Care Managers (RN’s) to ensure everything that a participant needs to tend to their health is arranged or taken care of.   Serve as the “super user” amongst the group; handle escalated cases.


Responsibilities:
     Care team support and improvement. Document, arrange, and ensure execution of escalated cases; troubleshoot system and delivery issues such as:
1.     Authorizations
2.     Home care scheduling
3.     Non-emergency medical transportation
4.     Provision of necessary medical supplies
5.     Follow-up of service placement to ensure received
6.     Coordinate with relevant departments such as UM, Medical Management and multiple Emblem vendors
         Improve inbound member and provider service for all products: provide research and issue resolution as necessary;    ensure participant or providers inquiries and questions are answered; lead resolution of member and provider problems.
         Serve as Subject Matter Experts for UM/Medical Management Department with respect to setting up Referrals and Prior Approvals on the Web site.
         Care Enhancement: Identify barriers to member care, elevate awareness of member or provider need, and work with team to develop solutions.
         This may include but is not limited to contacting providers, adding additional requests to a case, creating new cases and forwarding clinical information to Medical Review for further approval. 
         Regular attendance is an essential function of the job.

         Perform other duties as assigned or required.

 Qualifications:

  • Bachelor’s Degree required; additional years of experience can be used in lieu of educational requirement.Associate’s Degree or Medical Assistant certification preferred
  • Minimum 2 - 3 years’ experience in health care and/or regulatory related environment
  • PC proficiency: accurate data entry/typing; word processing; database/spreadsheet; presentation; e-mail.
  • Administration and organizational skills
  • Ability to perform independently and prioritize projects and assignments
  • Ability to exercise discretion in relationships with internal and external contacts; and to understand and adhere to confidentiality and proprietary requirements.
  • Understanding of and sensitivity to cultural differences and needs of community members.
  • Proven ability to operate within a diverse and multi-cultural work environment and community of members such as Spanish, Chinese, Russian, Creole and Korean

 

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.

Previous Job Searches

Similar Listings

Albany, New York

📁 Administrative & Support

Albany, New York

📁 Administrative & Support

Albany, New York

📁 Administrative & Support