Job Title: Care Worker (649066)
Location: Phoenix AZ 85034
Duration: 3 Months Temp to hire
Facilitates department workflow by supporting clinical team with various care coordination workflows. Locates community services and other referral locations for enrollees, arranges access to care, supports communication with hospitals, and providers.
Provides non-clinical support to ensure cases meet timeliness as contracted with Health Plan
Make Out bound calls to schedule cases for Physician review and for notification of case status.
Provide Physician Reviewers pre populated templates for reviews and post clinical information received back from reviewers into cases.
Answer inbound calls related to scheduling and research of existing cases.
Prepare denial letters utilizing Health Plan specific templates copying member and clinical information from Physician notes.
Assists in the mentoring and training of new Care Workers.
Participates in other operational activities, including data collection, tracking, and analysis.
Must have 2-3 years in a complex customer service /admin experience. Call center experience only will not be considered.
Experience in a managed care environment, integrated medical and behavioral health care and/or training in chronic pain management.
Understanding of plan benefit structures, psychiatric/medical terminology, and local communication resources.
For roles supporting the Chronic Pain Management SBU, understanding of Chronic Pain Management guidelines and workflows is also required.
Education: HS or GED (no special licensing or certifications)