AmeriHealth Caritas Care Connector in Charleston, South Carolina
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com
Under the supervision of the Supervisor of Integrated Case Management, the Care Connecter provides select program interventions according to established health management program guidelines and the member population. The incumbent functions with the direction from the program's Case Manager or Supervisor/Manager and is responsible for screening identified members based on the plan stratification for the program. Interacts with members, providers and other staff to implement program interventions, document activities, assist providers in the authorization process and refer risk appropriate members to professional staff according to protocols.
- Supports the daily operations of Rapid Response through interaction with staff, facilities, vendors and providers.
- Maintains a current knowledge base of Rapid Response processes and timeliness.
- Uses good listening skills, conducts outreach calls, collects data according to script, tools, and protocols meeting both productivity and performance expectations as identified by unit supervisor/or designees. Conducts all calls in a courteous and customer service friendly manner. Refers as appropriate when indicated by workflow.
- Creates updates, maintains and/or closes authorizations or tasks for services as assigned within process guidelines. Routes case to appropriate associates based on established guidelines.
- Processes all incoming and outgoing correspondences/faxes in accordance with required standards and within respective timeliness guidelines. Refers to the appropriate clinical team members for review as defined by workflow.
- Performs in a call center environment appropriately processing or triaging calls from members and providers.
- Communicates directly with members to identify needs, and provide information on health care access and preventative health interventions and screening.
- Clerical responsibilities such as processing urgent scanning, mailing requests and document retrieval.
- Demonstrates a professional and courteous manner when communicating with others with the ability to clearly and accurately state the agreed upon resolution.
- Adheres to AmeriHealth Caritas FoC Policies and Procedures, process standards, Standard Operating Procedures and maintains current knowledge of member benefits, rights and responsibilities.
- Performs other related duties and projects as assigned within the assigned timeframes.
- Adheres to AmeriHealth Caritas Family of Companies policies and procedures.
- Supports and carries out the Caritas Mission & Values.
- Complies with Amerihealth Caritas FoC and HIPPA confidentiality standards to protect the confidentiality of member information.
- High School Diploma or equivalent required
- Minimum 2 years of member service or customer service experience in a call center environment, preferably within a managed care organization
- Proficient working in a Windows based environment and utilizing MS Office products (Word, Excel, and Outlook)
- Proficiency working with electronic documentation and medical record programs
- Working knowledge of medical terminology
- Strongly prefer Medical Assistant, Home Health Aide, Nursing Assistant or similar healthcare para-professional training or certification
EOE Minorities/Females/Protected Veterans/Disabled