The Social Work Care Manager provides telephonic support for members' medical, psychosocial, and spiritual needs while developing person-centered service plans. They ensure continuity of care by collaborating with interdisciplinary teams and educating members on disease processes and preventative health.
The Transitional Care RN acts as a patient advocate by facilitating and coordinating the transition of patients to the next level of care. This role involves collaborating with facility discharge planners and case management staff through telephonic outreach and in-person assessments.
The representative will respond to member and provider inquiries regarding benefits, claims, and complaints within a call center environment. They are responsible for documenting all interactions and processing requests for claim adjustments or disenrollment.
Provide comprehensive case management to members by addressing their medical, social, psychological, physical, and spiritual needs. Develop, implement, and monitor individualized care plans in collaboration with primary care physicians and the care team.
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.
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.
