Processes service requests in accordance with Medicare and NYS Medicaid guidelines while collaborating with care managers and physicians. Coordinates the completion of UAS NY assessments and ensures member care plans are accurately updated.
The RN Care Manager conducts telephonic assessments to develop and revise person-centered service plans based on member needs. They also facilitate interdisciplinary care team meetings and educate members on advanced directives and healthcare documentation.
The RN Care Manager provides comprehensive case management by addressing the medical, social, psychological, physical, and spiritual needs of members. They are responsible for developing, implementing, and monitoring individualized care plans in collaboration with primary care providers and caregivers.
Handle member and provider inquiries regarding benefits, claims, and complaints within a call center environment. Record call details and process requests for claim adjustments and disenrollment.
Handle member and provider inquiries regarding benefits, claims, and complaints within a call center environment. Record call details and process requests for claim adjustments and disenrollments.
Manage a high volume of incoming calls and emails while researching solutions for callers. Log all interactions into computer systems and maintain professional dialogue during difficult situations.
