Care Management Specialist

Fairview Health Services • Edina, MN

404d • Remote

About The Position

The Care Management Specialist at M Health Fairview is responsible for establishing and maintaining relationships with providers, patients, families, and vendors, serving as a liaison between Fairview Partners and health plans for community enrolled members. This hybrid role supports Care Coordinators and involves coordinating services, managing referrals, and ensuring accurate reporting for health plan members.

Requirements

• Two year degree in a healthcare-related field, or minimum equivalent work experience of four years in a health care setting.
• Two to four years of recent experience in a health care setting.
• Two to three years of recent experience with Microsoft Word, Excel, and Access.

Nice To Haves

• Four years of experience in a health care setting.
• Three years of experience with EPIC, Microsoft Word, Excel, and Access.
• Previous experience with referrals processing in a medical office.

Responsibilities

• Serve as a liaison to patients, vendors, providers, and health plan representatives to resolve issues related to billing and health plan referral verification.
• Assist case managers or providers with utilization, authorization, and claims payment as appropriate and requested.
• Coordinate and facilitate services as directed by the Care Coordinator.
• Approve/Direct patient referrals to appropriate settings and understand benefit structures of contracted health plans.
• Communicate directly with vendors, clinics, and payers or as needed to patients.
• Review health plan member reports for accuracy and work with health plans and care coordinators to correct discrepancies.
• Utilize Excel and Access database to report new member information to providers and internal entities of Fairview.
• Assist Care Coordinators in coordinating and ordering services for community members, including working with home care agencies and community agencies.
• Research community resources for Fairview Partners members and develop relationships with new vendors.
• Document member information using EPIC and the Department of Human Services reporting system.
• Monitor and process changes to member's health plan status and other internal tracking spreadsheets.
• Assist members in transportation, appointment, and DME & supply requests.

Benefits

• Medical/Dental insurance
• 401k/403b with employer match
• Tuition reimbursement
• Paid time off (PTO)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: Associate degree