Care Management Associate

About the Role

The Care Management Coordinator plays a key role in supporting healthcare management activities that improve quality outcomes, promote cost-effective care, and enhance operational efficiency. This position is responsible for coordinating member services, triaging care management activities, identifying appropriate interventions, and supporting the development and implementation of care plans. The role serves as a liaison between members, providers, clinical staff, and internal business partners to ensure effective delivery of healthcare services.

Key Responsibilities

Care Coordination & Member Support

• Support the coordination of healthcare services through intake, screening, referral management, and care plan implementation.
• Conduct initial review and triage of Care Team tasks and member cases.
• Identify the principal reason for admission, facility type, and member product to accurately apply assessment and intervention tools.
• Screen members using established clinical and business rules to identify appropriate healthcare services and referrals.
• Coordinate services in accordance with benefit plans and organizational guidelines.
• Monitor cases to ensure accurate discharge dates and dispositions are documented.
• Identify and escalate complex or outlier cases, including extended length-of-stay situations, to clinical staff.
• Recognize opportunities for referral to Case Management, Disease Management, Specialty Programs, and other care management services.

Care Plan Support

• Assist with the development, implementation, and coordination of care plans under the direction of nurses and medical directors.
• Help members access the most appropriate providers and services while supporting cost-effective care delivery.
• Promote member engagement and continuity of care throughout the healthcare journey.

Communication & Collaboration

• Serve as a primary point of contact for members, providers, and internal stakeholders.
• Facilitate communication between healthcare providers, care teams, and business partners to support positive member outcomes.
• Provide administrative and operational support to care management staff, including responding to inquiries, researching information, and resolving routine issues.
• Participate effectively in multidisciplinary team environments.

Documentation & Compliance

• Maintain timely, accurate, and complete case documentation in accordance with company policies, regulatory requirements, accreditation standards, and risk management guidelines.
• Protect the confidentiality of member information and ensure compliance with HIPAA and organizational privacy standards.
• Support hospital care management, utilization management, quality management, and case management processes in accordance with applicable regulations and accreditation standards (NCQA, URAC, and CMSA where applicable).
• Assist with the research and resolution of claims payment inquiries when needed.

Systems & Administrative Support

• Utilize internal healthcare management systems to research, update, and maintain member information.
• Perform non-clinical research to support case management activities and case resolution.
• Maintain organized and accurate records across multiple systems and platforms.

Requirements & Tech Stack

Proficiency with:

• Microsoft Office Suite, including Outlook, Teams, Word, and Excel.
• Internal healthcare management systems.
• Electronic medical records (EMRs), healthcare databases, or care management platforms (preferred).

Qualifications

Required:

• High School Diploma or GED.
• 1+ year of experience in healthcare, call center, customer service, care coordination, case management support, utilization management, health insurance, hospital operations, or a related field.
• Strong verbal and written communication skills.
• Excellent organizational skills with the ability to manage multiple priorities in a fast-paced environment.
• Ability to handle confidential and sensitive information professionally.
• Strong problem-solving and customer service skills.

Preferred:

• Associate’s or Bachelor's degree in Healthcare Administration, Public Health, Nursing, Social Services, or a related field.
• Experience in managed care, healthcare operations, utilization management, case management, or health insurance.
• Knowledge of medical terminology, healthcare delivery systems, and insurance benefits.
• Familiarity with NCQA, URAC, CMSA, HIPAA, and regulatory healthcare standards.
• Experience supporting members, providers, or clinical teams in a healthcare environment.

Key Competencies

• Care Coordination
• Healthcare Operations
• Case Management Support
• Medical Terminology
• Customer Service Excellence
• Critical Thinking & Problem Solving
• Documentation & Compliance
• Time Management & Organization
• Interpersonal Communication
• Team Collaboration
• Data Entry & System Navigation