Case Manager Transplant

Principal Duties And Responsibilities

• Manage a caseload of 95+ members, acting as the primary point of contact.
• Arrange hospital transfers and emergency medical transport for transplants.
• Verify member eligibility and educate them on transplant and dialysis benefits.
• Handle high-stress calls, resolve member inquiries and provide guidance on next steps.
• Process new referrals and proactively research member accounts.
• Document all interactions and coordinate with various stakeholders.
• Address billing issues, claim denials and travel-related inquiries.
• Provide clear guidance on benefit parameters to ensure high member satisfaction.
• Work independently after hours to resolve urgent issues.
• Identify workflow gaps and contribute to process enhancements.
• Execute travel reservations and manage travel-related expenses.
• Cover for the supervisor when unavailable and act as a resource for team members.
• Assist in developing training materials and onboarding new staff.
• Manage on-call schedules, queue coverage and caseload/referral assignments.
• Maintain and analyze reports as needed.

General Expectations

• Present a positive image of Consociate Health at all times.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goals efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others.
• Attend required in-service and staff meetings.
• Seek other educational opportunities directly related to this position.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.
• Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries.

Required Experience

• High school diploma, GED, or equivalent.
• 1-3 years of experience in customer service, travel, healthcare or a related field.
• Ability to work independently and manage information flow.
• Ability to telecommute or reside in Central Arkansas.
• Proficiency in Office 365, Adobe and Excel.
• Must be certified and maintain Medical Travel Professional certification.
• College degree in healthcare, psychology, social work or a related field preferred.
• 5+ years of experience in customer service, travel, healthcare or a related field.
• Knowledge of medical terminology.
• Experience working with transplant patients.
• Ability to perform in high-stress, time-sensitive environments.