Career Center

Provides non-clinical support to workflows involving utilization management, case management, disease management, and health promotion. Troubleshoots when an appropriate provider, type of service, or appropriate level of care cannot be readily found. Has current knowledge or researches availability of community resources and services and link members to appropriate services. May assist in transitions in care for hospitalized patients and makes appropriate placements, if needed. Assumes responsibility for self-development and career progression. Proactively seeks and participates in ongoing training (formal and informal) in all aspects of the Care Worker role. Assists in the mentoring and training of new Care Workers. Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers. Coordinates and manages distribution of correspondence and materials to enrollees and providers. Participates in operational activities, including data collection, tracking, and analysis. RESPONSIBILITIES: 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. WORK 

EXPERIENCE: Managed Care 

EDUCATION: Associates (Preferred)