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Care Worker (607494)
Ref No.: 18-04239
Location: San Diego, California
Start Date / End Date: 05/07/2018 to 08/04/2018
Description:
Facilitates department workflow by supporting clinical team with various care coordination workflows. Locates community services and other referral locations for enrollees, arranges access to care, supports communication with hospitals, and providers.
ESSENTIAL FUNCTIONS:
- Provides non-clinical support to workflows involving utilization management, case management, disease management, and health promotion.
- Trouble shoots 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.

Requirements/Certifications:
-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.
Experience in a managed care environment, integrated medical and behavioral health care and/or training in case management
Must haves: Strong data entry, inbound/outbound calling (not a calling queue but is still call center). Must also be VERY flexible to change (new program meaning there will be learning, design & development as the program moves along). Should be computer savvy, have a good/clear speaking voice.
Like to have: Previous experience working in an office setting. Previous experience working for an insurance company.
Duration: temp to hire
Hours: 8:30am-5:00pm
Location: Preferably onsite in the San Diego office, but WILL consider remote in CA only.
Target Bill Rate: $27.20 (to customer)
Max Pay Rate: $18.13