Support the coordination of medical and social services for members by assisting with care team intake, task triage, outreach, and care plan implementation
Review, prioritize, and triage incoming Care Team tasks to ensure timely follow-up and resolution
Screen members using established guidelines and business rules to identify care needs and required services
Initiate referrals to Case Management, Disease Management, LTSS, and other specialty programs as appropriate
Conduct outreach to members, providers, and care team partners to support care coordination efforts
Utilize internal systems to document member information, outreach, and case activity accurately and timely
Support the development and implementation of member care plans under the direction of clinical staff
Coordinate healthcare services and assist in identifying in-network, cost-effective care options
Perform non-clinical research to support case development, maintenance, and closure
Communicate effectively with internal teams, providers, and members to facilitate care delivery
Provide administrative and operational support, including call handling, issue resolution, and task follow-up
Maintain accurate, complete, and audit-ready documentation in compliance with company policies and regulatory requirements
Adhere to all compliance standards, including CMS, NCQA, URAC, and internal quality guidelines

2–4 years of experience in a healthcare setting (e.g., medical assistant, office assistant, care coordination support)
Strong computer proficiency, including Microsoft Word and Excel
Ability to navigate multiple systems and manage tasks efficiently in a fast-paced environment
Strong verbal and written communication skills, including telephonic outreach
Knowledge of basic medical terminology and care management concepts
Excellent organizational and time management skills with attention to detail
Customer-focused approach with the ability to resolve issues proactively
Ability to collaborate effectively within a multidisciplinary team

Care Management Associate

Key skills