Case Specialist - Plan

JOB SUMMARY:The Case Specialist - Plan is responsible for managing care and services to members. Case Specialists works in conjunction with Case Managers to coordinate health care services by facilitating, scheduling, and arranging a variety of treatment and health care plans.PRIMARY RESPONSIBILITIES:1.Coordination, authorization, fulfillment, monitoring and tracking of health care services.
2.Establish working relationships with referral sources3.Initiates and maintains contact with assigned individuals/significant others and providers to determine members response to services.
4.Coordinate home visits for Case Managers.
5.Review of benefit systems.
6.Identifies cases in consultation with Case Manager that would benefit from alternative care.
7.Coordinates assignments for Case Managers to facilitate timely member evaluation.
8.Arranges for services as identified by the case manager such as home health resources, alternative long-term care placements etc.
9.Knowledge of care-coordination and case management concepts.
10.Identifies potential liability issues for services provided.
11.Utilizes knowledge of community resources.
12.Refers members to case management as indicated.
13.Ensures that health care services are received as authorized by the provider.
14.Collaboratively works with other departments.
15.Utilizes excellent customer service principles to assist internal and external customers.
16.Maintains member confidentiality.
17.Other duties as requested or assigned.PLEASE APPLY ONLINE AT: WWW.AMERIGROUPCORP.COM
REQUIREMENTS
JOB REQUIREMENTS:Education and Experience:
•Associate Degree required (or equivalent experience)
•Bachelors degree preferred
•Medical Terminology preferred
•Minimum of (2) years working in Health Services field
•Bilingual an asset.
.
Certification and Licensure:
•N/A.PLEASE APPLY ONLINE AT: WWW.AMERIGROUPCORP.COMKnowledge and Skills:
•Computer literate
•Excellent verbal and written communication skills.
•Strong decision making skills.
•Ability to provide services in an environment that involves multiple health care systems.
•Ability to interact with all relevant components of the health care system.
•Ability to provide services that deal with the individuals broad spectrum of needs
•High energy level.
•Self-starter with ability to handle multiple projects at one time.•Appreciation of cultural diversity and sensitivity towards target population.
•Bilingual a plus.Physical Requirements:
•Must be able to operate a computer.
•Must be able to operate a telephone.SCOPE INFORMATION
ItemMeasure
•# Direct Reports0
•# Indirect Reports0
•Budgetary $ ResponsibilityN/A