ocation: Remote, 30% travel to members homes. MUST live in Farmington/Gallup area.
Job Summary
This role supports members in managing their health care needs through outreach, education, and home health assessments. The position works closely with the Medical Management and clinical teams to encourage care plan adherence, respond to member and provider inquiries, and support case activities through documentation and coordination.
Key Responsibilities
- Conduct home health assessments and update member information
- Perform outreach and follow?ups to educate members on health programs and care plans
- Build relationships with members to encourage participation and compliance
- Coordinate appointments, transportation, and additional member services
- Complete data entry, documentation, and member correspondence
- Support clinical staff with non?clinical case activities
- Respond to phone and written inquiries from members and providers
- Assist with claims?related research and case coordination
- Meet productivity standards and maintain confidentiality
- Comply with HIPAA and company policies
Qualifications
Required (one of the following):
- Bachelor’s degree in Social Work or Psychology
- LVN/LPN with 1+ year managed care experience
- RN
- 3+ years care coordination or managed care experience
Skills:
- Knowledge of medical terminology
- Strong customer service and communication skills
- Experience supporting member medical needs
- Microsoft Office proficiency
- Motivational interviewing or coaching experience preferred
Additional Requirements:
- Valid driver’s license, reliable transportation, and insurance
- Ability and willingness to travel
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