Care Manager Specialist - Cms

Care Manager Specialist – Cms

2+ years of experience in a health-related field
2+ years of customer service experience
Technical Proficiency: Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and ability to effectively utilize these tools within the CMS role.
Work Environment: Access to a private, dedicated space to conduct work effectively to meet the requirements of the position.

Dedicate 50-75% of the day to engaging with members and coordinating their care.
Utilize all available resources to connect with and engage ‘hard-to-reach’ members.
Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs.
Maintain meticulous documentation of care management activities in the member’s electronic health record.
Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
Identify and connect members with health plan benefits and community resources.
Meet regulatory requirements within specified timelines.
Consults with the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making.
Collaborates and leverages the Care Manager RN clinical expertise to ensure members’ needs are adequately addressed.
Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.

Experience providing care management for Medicare and/or Medicaid members
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating the care planning processes
Bilingual skills, especially English-Spanish