Job Title: Case Management Associate Analyst (100% REMOTE) Duration: 6+ Months Schedule: 10:30-7 PM CT Note: Candidates can be located in any time zone as long as they can commit to the CST hours for the role.Candidates MUST have a reliable internet connection.
Top 3 skills needed in candidates are empathy, strong technology skills, and multi-tasking.
Duties:
Complete scheduling of peer reviews for all lines of business (CAMS, TruCare, and CareAllies) which includes building and verifying template information, making outbound/receiving inbound calls from facilities and providers to schedule reviews, coordinating MD/PHD calendars, documenting in the case, assigning for follow-up, and notifying Care Managers.
Provide verbal determination to facilities and providers on results of peer reviews.
Complete follow-up on cases after peer review including: creating alternative level of care authorizations, discharge planning, and appeal requests.
Utilize workflows efficiently to ensure accurate documentation and adhere to compliance guidelines.
Responsible for management of MD Scheduling mailbox.
Work closely with internal matrix partners to ensure legal, federal, and state mandates are in compliance, and NCQA and URAC accreditation guidelines are met.
Proficiently communicate with matrix partners including appeals coordinators, case managers, medical directors, individual HCP's, and facilities.
Provide exceptional customer service, collaborating closely with matrix partners, to ensure each case is completed and effectively communicated to the customer and facility in a timely manner.
Additional tasks as assigned.
Skills:
At least 2 years of experience in behavioral health services setting.
Strong verbal, written, and interpersonal communication skills.
Effective listening and analytical skills.
Extremely detail-oriented and proficient in organizational skills.
Strong ability to switch-task and exhibit excellent prioritization skills.
Experience working on multiple projects simultaneously under tight deadlines.
Technical knowledge of automated databases, tracking systems, and spreadsheet applications.
Ability to manage change effectively and assist in leading others through the change process.
Education:
Bachelor's degree in mental health field or psychology/social work related field required (can also include: family communications, health coaching, community/public health or other related major).
This is a non-clinical role and does not require a license.
Previous customer service experience or related position.
CPRA: Notice to California Applicants: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
