Case Management Associate – Maternity

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🏄 California, Nevada, +1 more states – Remote

🏄 California – Remote 🎰 Nevada – Remote ☕ Washington – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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ProgenyHealth, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

☁️ SaaS

🧘 Wellness

Healthcare Insurance • SaaS • Wellness

ProgenyHealth, LLC is a company focused on transforming healthcare for women, infants, and families through its integrated Maternity and NICU Care Management solutions. With over 20 years of experience, ProgenyHealth provides a comprehensive care management solution to address the maternity and NICU challenges faced by modern health plans. By identifying risks early, the company aims to prevent preterm births, NICU stays, and complications during pregnancy and after delivery. ProgenyHealth operates as a trusted partner for health plans, overseeing a full maternal and infant care continuum, creating lasting relationships, and optimizing maternal and infant healthcare economics. The company also helps solve non-clinical social drivers impacting maternal and infant health, ensuring equitable, standardized, and predictable family care.

📋 Description

• The Case Management Associate will assist the Case Management department in the administration of CM functions to include telephonic outreach to members; monitoring of member eligibility; updating database information and research of support services for families. • Works to support the Case Managers in developing open communication with members. • Freely helps and directs callers to the correct staff member in a friendly, helpful, and courteous manner using principles of good customer service. • Verifies member eligibility following appropriate ProgenyHealth policies, procedures, and workflows. • Conducts outreach and follow-up calls daily to members and providers as directed by CM Leadership to: 1) Introduce Maternity CM program, mobile App and initiate intake screening tool. 2) Assist with obtaining necessary information to support CM activities (member demographics, provider contact information, researching community resources). 3) Transfer member to Case Manager or Care Coordinator for assessment completion or schedule an appointment for the member to speak with them at a later date and time. • Documents member and provider information and calls in the medical management database as needed with member and provider data. • Data entry into client-based systems as directed by CM Leadership. • Completes scripted introduction calls to Provider office. • Transfers any questions of a clinical nature from member or provider to Nurse Case Manager. • Directs members to client point of contact for complaint calls and documents information received and notifies Supervisor. • Assists with research of these issues if asked to do so by Supervisor. • Attends and participates in meetings to discuss Quality Improvement updates and concerns. • Attends ongoing training sessions related to Quality initiatives and participates in Quality Improvement projects as needed. • Advises supervisor immediately, if a quality-of-care issue is identified. • Protects the confidentiality of member information and adheres to company policies regarding confidentiality and PHI disclosure.

🎯 Requirements

• Must reside in one of the following time zones: CST/MST and/or PST. • 1 – 3 years of experience in customer service in a healthcare environment. • Bilingual (Spanish speaking) is preferred. • HS diploma or equivalent required. • College degree preferred. • Call center (outbound) experience strongly preferred. • Insurance/payor experience preferred. • Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas as well as interact professionally and effectively with members, clients, and staff from all departments within and outside the company. • Problem solving skills with the ability to look for root causes and implementable, workable solutions. • Must be proficient at an intermediate to advanced level in Outlook, Excel, PowerPoint, & Word. • Must be self-motivated and willing to learn multiple tasks. • Must be well-organized and able to prioritize tasks. • Must have commitment to excellence in customer service.

🏖️ Benefits

• 401K with company match • Medical and dental benefits • Long Term Disability • Paid Time Off