Care Management Support Coordinator II

Position Purpose: Supports Member Support Center through administrative and member support functions. Activities include performing outreach to providers offices, answering inbound calls, PCP changes, mailing out ID cards and other requested correspondence, reviewing transportation requests and scheduling services. Serves as a point of contact to members and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines. Education/Experience: Requires a High School diploma or GED Requires 1 – 2 years of related experience Provides outreach to members via phone to support with questions or concerns related to transportation redirection and reward program. Process Worklist Items (WLIs) and member requests. Handle PCP change requests, ID card requests, mail-outs, My HealthPays inquiries, Contact Us requests, complaints, escalations, and follow-up activities. Review Medical Transportation Program (MTP) requests requiring health plan approval. Verify member eligibility and benefits. Research authorizations, claims history, network participation, continuation of care, and medical necessity. Contact providers and members to gather supporting information when needed. Determine whether requests should be approved or denied and communicate decisions through the SafeRide process. Perform outbound calls and detailed research to resolve member and provider issues. Investigate benefit questions, transportation requests, provider access concerns, and other member service inquiries.

salary: $16.99 - $17 per hour shift: First work hours: 8 AM - 5 PM education: High School

Responsibilities

Maintain tracking logs and ensure accurate, timely documentation. Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service May apply working knowledge of assigned health plan(s) activities and resources Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship| Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed

Skills

• Call Center
• Customer service
• Medicaid experience

Qualifications

• Years of experience: 1 year
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.