Care Management Support Specialist

Role Overview

• Coordinates Care Management programming by utilizing multiple systems and tools to support member engagement and enrollment across Care Management, Quality, and Community Health services
• Serves as a liaison between members, Care Management teams, and external vendor partners to facilitate timely handoffs, follow-up, and issue resolution
• Supports efficient and effective digital and telephonic engagement workflows, including referral routing, outreach coordination, task tracking, and documentation follow-up
• Proactively identifies operational issues, access barriers, or workflow gaps impacting member experience or program performance and escalates concerns to appropriate clinical or leadership partners
• Provides day-to-day operational support to Care Management programs, helping ensure workflows are organized, efficient, and consistently executed
• Maintains and updates standard operating procedures (SOPs), job aids, trackers, and workflow documentation to support consistency, quality, and audit readiness
• Compiles and maintains operational reports, dashboards, and tracking tools related to referrals, outreach activity, timeliness, and program performance
• Supports accreditation and regulatory readiness by maintaining required documentation, evidence logs, and trackers in partnership with designated accreditation leads (URAC, NCQA, and applicable state and federal requirements)
• Serves as a care management platform super-user, supporting testing, upgrades, enhancements, and surveys; documents issues and coordinates resolution with IT and business partners
• Partners with internal subject matter experts to support program launches, enhancements, and continuous improvement efforts as business needs evolve
• Maintains confidentiality of all regulated information in compliance with state and federal laws, including PHI and PII, and follows all corporate, divisional, and departmental policies and procedures
• Meets established individual and program performance standards, including productivity, quality, and service expectations
• Manages workload independently, handles multiple priorities simultaneously, and works with minimal supervision
• Performs other duties as assigned

Requirements

• Associate degree in business administration, healthcare management, or a related field, or an equivalent combination of education and experience in healthcare operations, care coordination, health insurance, or a related support role
• 1–3 years of professional experience in healthcare operations, care coordination, health insurance, or a related support role
• Experience navigating multiple systems and tools to support members and internal teams across various communication channels
• Working knowledge of health insurance concepts, benefits, and healthcare navigation
• Strong organizational, communication, and problem-solving skills
• Proficiency with Microsoft Office applications

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program