About the job
JOB SUMMARY:
The Care Worker plays a vital role in enhancing the efficiency of departmental workflows by providing essential support to the clinical team across various care coordination processes. This includes identifying community services and referral locations for enrolled members, facilitating access to care, and ensuring effective communication with hospitals and healthcare providers.
ESSENTIAL FUNCTIONS:
- Assist with non-clinical support for workflows related to utilization management, case management, disease management, and health promotion.
- Address challenges in locating suitable providers, services, or levels of care when necessary.
- Maintain current knowledge of community resources and services, linking members with appropriate services and supporting transitions in care for hospitalized patients.
- Take initiative for personal development and career advancement by actively seeking ongoing training and mentoring opportunities. Provide guidance to new Care Workers and stay informed on relevant updates to ensure accurate member and provider interactions.
- Oversee the distribution of correspondence and materials to enrollees and providers.
- Engage in operational activities, including data collection, tracking, and analysis.
- Experience in a managed care environment, familiarity with integrated medical and behavioral healthcare, and/or training in chronic pain management is beneficial.
- Possess an understanding of plan benefit structures, psychiatric/medical terminology, and local communication resources.
