Introduction
To heal, to teach, to discover and to advance the health of the communities we serve.
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Overview
Working under the supervision of a licensed/certified clinical professional, the Care Management Analyst (CMA) is responsible for managing operational processes for care management programs that include, but are not limited to complex care, chronic care, palliative care, and care transitions programs.
Responsibilities
- The CMA collects and organizes information from multiple sources including members, caregivers, physicians, clinical information systems and electronic health records.
- The CMA uses this information to make decisions regarding the appropriateness of utilization and benefit application for specific health care services and/or directs this information to appropriate staff for intervention/follow-up in accordance with established organizational and/or departmental protocols, policies and procedures.
- The CMA may assume responsibility for managing the above activities for a case load of members or may manage specific processes and tasks related to case management and utilization management activities.
- The CMA interfaces with and acts as a resource to team members, other MMC and CMO departments, members/caregivers and physicians/care providers.
Requirements
- Associate Degree required, Master's Degree preferred.
- LPN (Licensed Practical Nurse, with valid NYS registration).
- 2 years' experience.
- Preferred experience in Hematology/Oncology and Medication prior authorization.
- Medical Management experience in a managed health care setting preferred.
- Appropriate training and experience in case management preferred.
Equipment Operation:
- MS Office, email, internet.
- Experience working within case/utilization management systems, data entry and typing.
- Automatic phone distribution systems.
- Electronic fax systems.
- Copier/scanning machine.
- Familiarity with web-based information systems.
