Company Statement

Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions.  WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.

 

To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.
 

Care Specialist (PA/Fax)

📁
Administrative & Support
💼
EmblemHealth
Sign Up for Job Alerts

Schedule: Monday-Friday 10:30am-7pm & every 3rd weekend Saturday or Sunday 8:30am-5pm

Department operates 7 days a week/365 days a year including holidays

 

Summary of Position

• Responsible for the execution of the non-clinical aspects of the Utilization Management process.
• Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations,
request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a
case.
• Work seamlessly with other interdisciplinary teams to ensure members’ needs are met.
• Provide confidential administrative support and assistance to the department in all aspects of daily program operations.

Principal Accountabilities

• Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities.
• Perform accurate and timely intake and data entry for all UM authorization requests and referrals for all lines of business, upon receipt of inbound utilization management requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements.
• Triage cases and assign receipts to appropriate teams.
• Respond to inquiries from providers, facilities and members.
• Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
• Enter and maintain documentation in the medical management workflow tool, meeting defined timeframes and performance standards.
• Provide phone management for both incoming and outgoing calls.
• Communicate with members and providers as required.
• Perform other related projects and duties as assigned.
• Adhere to processes for collecting member-specific clinical and demographic data from providers and other
entities as required by clinical staff.
• Support communication and coordination with delegated entities, as necessary.
• Actively participate in assigned committees and projects.

Education, Training, Licenses, Certifications
• High School Diploma required
• Associates degree or Bachelor’s degree in related field preferred

Relevant Work Experience, Knowledge, Skills, and Abilities
• At least 1-2 years of previous client-facing or data entry experience in a health care environment.
• Additional years of experience/certifications/training may be considered in lieu of educational requirements.
• Strong oral, written and interpersonal communication skills required.
• Ability to work both independently and collaboratively with others.
• Previous system user experience in a highly electronic environment required.
• Proficiency in Microsoft Office suite skills required.
• Knowledge of medical terminology and medical payment preferred.
• Ability to prioritize multiple tasks.
• Required to work weekends and holiday as necessary.

Previous Job Searches