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Case Management Processor
Ref No.: 18-12163
Location: Albuquerque, New Mexico
Start Date / End Date: 10/08/2018 to 01/05/2019
Request ID: 3125-1
Job Title: Case Management Processor
Location: Albuquerque, NM 87102
Duration: 3 Months

Job Description:
  • Provides support to the Case Management staff performing non clinical activities and supporting the management of the department.
  • Responsible for initial review and triage of Case Management tasks.
  • Reviews data to identify principle member needs and works under the direction of the Case Manager to implement care plan.
  • Screens members using Client policies and processes assisting clinical Case Management staff as they identify appropriate medical services, Coordinates required services in accordance with member benefit plan.
  • Promotes communication, both internally and externally to enhance effectiveness of case management services (e.g., health care providers and health care team members).
  • Runs reports to assist in coordination of case management needs.
  • Provides support services to case management team members by answering telephone calls, taking messages and researching information.
  • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
  • Protects the confidentiality of member information and adheres to company Knowledge, Skills and Abilities (List all knowledge, skills and abilities that are necessary to perform the job
  • satisfactorily)
  • Strong customer service skills to coordinate service delivery including attention to members/customers, sensitivity to concerns, proactive identification and resolution of issues to promote positive outcomes for members
  • Demonstrated ability to communicate, problem solve, and work effectively with people
  • Working knowledge of medical terminology and abbreviations
  • Ability to think analytically and to problem solve.
  • Good interpersonal/team skills
  • Must have a high regard for confidential information ¿ Ability to work in a fast paced environment ¿ Able to work independently and as part of a team.
  • PC experience in Windows environment and accurate data entry at 40 WPM minimum.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education:
  • High School Diploma or G.E.D.

Required Experience:
  • Two or more years experience as a medical assistant, office assistant or other healthcare service administrative support role.