Posted on: June 18, 2022
Epitec POSITION:Case Manager
JOB TYPE:W-2, Contract
JOB SUMMARY FOR CASE MANAGER:
- This position is responsible for conducting home health
assessment, contacting identified members to inform and educate
them on health care programs to address their personal health plan
needs, engaging the member in discussion of adherence to personal
health plans, responding to inquiries from members, and supporting
the clinicians in the Medical Management department with their
provider and member activities.
RESPONSIBILITIES FOR CASE MANAGER:
- Responsible for home health assessments and system
- Perform outreach and follow up attempts to members on their
health care plan.
- Build relationships with members to encourage compliance with
care plans and to alert the Case Manager quickly when issues
- Inform and educate members on their program, may use supplied
scripts. Complete records in system by performing data entry.
Encourage member usage of our programs, including arranging
appointments and additional member services (e.g., transportation).
Generate appropriate correspondence and send to member manually,
electronically, or telephonically.
- Conduct check-ins with members to review individual care plan
- Maintain production requirements based on established
department business needs.
- Provide support to the clinical team by performing the
non-clinical functions (as identified by the business process)
necessary to generate, manage, and close a case within the
- Receive, analyze, conduct research and respond to telephone
and/or written inquiries. Process information from member or
provider to determine needs/wants and ensure customer questions
have been addressed. Respond to customer or send to appropriate
- Notify help desk of system issues.
- Perform data entry function to update customer or provider
- Obtain required or missing information via correspondence or
- May serve as contact for the various groups regarding claims
which involves conducting research, obtaining medical
records/letters of medical necessity from TMG, reopen or initiate
new cases as needed and refer case to clinicians.
- Support and maintain communications with various in-house areas
regarding groups' concerns, i.e.: Marketing, Provider Affairs, and
- Communicate and interact effectively and professionally with
co-workers, management, customers, etc.
- Comply with HIPAA, Diversity Principles, Corporate Integrity,
Compliance Program policies and other applicable corporate and
- Maintain complete confidentiality of company business.
- Maintain communication with management regarding development
within areas of assigned responsibilities and perform special
projects as required or requested.
REQUIRED EXPERIENCE FOR CASE MANAGER:
- RN OFR LVN, LPN with 1 year experience in managed care systems
OR 3 years care coordination for a state managed or waiver program
OR 3 years managed care systems experience.
- Knowledge of medical terminology
- Experience coordinating member medical related needs, providing
assistance to members, and analyzing member needs
- PC proficiency including Microsoft Office applications
- Customer service skills
- Verbal and written communications skills including developing
written correspondence to members and to other department personnel
and coaching skills, including motivational interviewing, to
educate members on medical issues
- Current state driver license, transportation, and applicable
- Ability and willingness to travel
Keywords: EPITEC, Roswell , Case Manager, Executive , Roswell, New Mexico
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