Case Management Specialist

Job Summary

A Case Management (CM) Specialist lends administrative support to Case Managers and Care Coordinators in the Case Management program. As a team member, you will regularly collaborate and engage with other team members to support daily operational tasks and duties assigned. Along with ensuring accuracy and efficiency, this role requires significant attention to detail, ability to prioritize and organize your work and regularly assess current workflows and create efficiencies. Duties are primarily performed in a virtual work environment.

Government Reporting

Direct

Education & Experience

Required

• High School Diploma or G.E.D.
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background
• investigation.
• Minimum 2 years’ experience in a health care customer service environment
• Experience with Microsoft Office suite

Preferred

• Medical Assistant (MA) or Certified Nursing Assistant (CNA)
• Knowledge of Medical Terminology
• Prior experience in a Managed Care Organization (MCO)
• Prior experience with TRICARE or VA health plans

Key Responsibilities

• Proactively evaluate and process assigned tasks within the medical management system
• Schedule and manage meetings in Outlook and system calendaring functions
• Process requests for beneficiary and/or provider education within established timeframes
• Handle incoming and outgoing phone calls, including an inbound phone queue regarding care coordination or case management inquiries in an efficient and professional manner
• Respond to daily email messages in an efficient and professional manner
• Utilize standard program processes to respond to beneficiary, provider and staff requests
• Support the CM leadership team by coordinating tasks and day-to-day activities, as requested
• Efficiently identify and resolve issues or address barriers to daily work
• Foster cross-functional communication with other organizational teams/departments
• Ability to work independently and collaboratively in a fast-paced environment
• Performs other duties as assigned
• Regular and reliable attendance is required

Competencies

Technical Skills

Working knowledge of the healthcare system and medical terminology. Knowledge of TRICARE programs and benefits, managed care programs or other government healthcare programs.

Problem Solving / Analysis

Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.

Organizational Skills

Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

Multi-Tasking / Time Management

Prioritize and manage actions to meet changing deadlines and requirements within a high volume, sometimes stressful environment.

Independent Thinking / Self-Initiative

Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.

Communication / People Skills

Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

Team-Building / Team Player

Influence the actions and opinions of others in a positive direction and build group commitment. Respectful behavior in a diverse workforce

Empathy / Customer Service

Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position. Respectful behavior when working with a diverse population

Computer Literacy

Ability to function in a multi-system Microsoft environment using Word, Outlook, TEAMs, TriWest Intranet, the Internet, and department software applications.

Commitment to Task

Ability to conform to established policies and procedures; exhibit high motivation.

Working Conditions

Working Conditions

• Extensive computer work with prolonged sitting
• Virtual team members and workflows
• Ability to do repetitive work and maintain production standards
• Department of Defense security clearance required

** This job description indicates the general nature and levels of work expected of the incumbents. It is not designed to cover or contain a comprehensive listing of activities, duties, responsibilities or competencies required of an incumbent. Incumbents may be asked to perform other duties as required. **