Job Description

Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.

Position Summary

Support Transplant COE patients by following their treatment plans, coordinating with carrier care managers and acting as a liaison between COE facilities and referring parties. Determine appointment eligibility under the program and communicate with patients and stakeholders.

Principal Duties And Responsibilities

• Clinical Judgment & Patient Management: Assess patient eligibility, facilitate case management, evaluate appointments per COE guidelines and assist with medical travel inquiries.
• Member Support & Education: Provide compassionate support, educate members on program policies and notify stakeholders of benefit end dates.
• Communication & Liaison: Serve as a primary contact between COE facilities and Care Managers, handle high-volume calls and triage inquiries.
• Customer Service & Relationship Management: Maintain accurate records, update member/vendor portals, and foster positive relationships with vendors, staff and providers.
• Administrative Duties: Submit coverage checks and claims, participate in meetings and identify resources for issue resolution.
  
  

General Expectations

• Present a positive image of Consociate Health at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer or co-worker.
• 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/goal 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.
  
  

Benefits

• Paid time off
• Paid Holidays
• Medical, Dental and Vision Insurance
• Basic Group Life, Short Term and Long Term Disability
• Voluntary Life, Critical Illness and Accident Coverage
• 401K Plan: Employees are immediately eligible with a 2% automatic enrollment. Consociate matches up to 4% of an employees' annual salary.
  
  

Required Experience

SERVICE EXPECTATIONS:

• Greet all people in a prompt and courteous manner. Communicate in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
• Ask customers what they need and strive to exceed their expectations. Offer and provide assistance whether or not the request falls within your specific job duties.
• Respond to customer requests in a timely manner consistent with Consociate Healths standards and best practices, return calls promptly and keep them informed of delays before they ask.
• Make decisions based on customer needs, opinions, complaints or suggestions.
• Take appropriate steps to resolve problems to the customer's satisfaction.
• Ask customers for their opinions, accepting criticism as an opportunity to improve service.
• Seek opportunities, provide value-added services, and eliminate tasks that do not serve our customer.
• Remain aware of products and services provided by Consociate Health.
• Project a positive, professional image when working.
  
  

Knowledge, Skills And Ability Requirements

• Associate or Bachelor of Science in Nursing required.
• Current, unencumbered RN license required.
• Basic proficiency in Microsoft Office. (Word, Excel, Teams, Outlook)
• Minimum 1 year of clinical nursing experience required.
• Case Management certification (must be obtained within 2 years of hire).
• 3 years of clinical nursing experience preferred.
  
  

Reporting Structure

• Reports to Transplant Nurse Care Management
  
  

Keyword: Nurse Care Manager