GENERAL SUMMARY
Responsible for the proactive identification of members with special needs based on referrals from within or outside of the health plan. Coordinates access to care and services that are appropriate to the member’s condition or circumstance.
ESSENTIAL RESPONSIBILITIES
- Responsible for reviewing state and/or health plan reports that identify members classified with special needs. Initiates referrals to case management as appropriate.
- Assesses members access needs for primary, specialist, durable medical equipment, and community services. Provides assistance to members to obtain necessary services to avoid delay in treatment.
- Compiles, documents, and maintains all appropriate documentation. Assists members with the completion of all necessary applications. Secures required data and submits the necessary documentation to the appropriate government office. Provides follow-up on all pending applications as required.
- Interfaces with members via telephone, written communication, and/or home visits.
- Collects and analyzes program data. Prepares reports that identify and interpret trends to assist in identifying members needs.
- Serves as a liaison between members, providers, and staff.
- Consults with health plan Medical Director on special needs cases as necessary.
- May participate in state directed meetings and/or in-services on providing care and coordination of care for the special needs population.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree of equivalent experience.
- Previous (1-3 years) experience working with special needs populations similar to those served by Medicare and/or Medicaid.
- Licensed or certified medical professional, social worker, teacher, or psychologist preferred.
- Strong written and verbal communication skills.
- Demonstrated computer skills with working knowledge of Excel and IDX preferred.
- Must be detail-oriented.
- Must be able to work with minimal supervision.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Harrisburg, PA, US
Organization: 23000 - HealthAmerica Pennsylvania Inc
Schedule: Full-time
Job Posting: 2012-12-20 00:00:00.0
Job ID: 1212724