**Experienced Case Management Specialist – Remote Customer Service Representative**

**Join arenaflex in Revolutionizing Patient Care** Are you passionate about delivering exceptional customer service and making a meaningful impact in the lives of others? Do you thrive in a dynamic, fast-paced environment where no two days are ever the same? If so, we invite you to join arenaflex as a Case Management Specialist – Remote Customer Service Representative. As a key member of our team, you will play a vital role in helping us achieve our mission of providing unparalleled patient care and support to our Double Qualified Special Needs Plan (DSNP) members. **About arenaflex** arenaflex is a leading healthcare organization dedicated to serving the unique needs of our DSNP members, who are enrolled in both Federal Medicare and Medicaid and face complex health and social challenges. Our team of compassionate professionals is committed to delivering top-tier care and support, working collaboratively with individuals, providers, and community organizations to address the full continuum of our members' healthcare and social determinant needs. **Position Overview** As a Case Management Specialist – Remote Customer Service Representative, you will utilize your exceptional communication and problem-solving skills to facilitate the case management process, ensuring that our DSNP members receive the most effective and efficient care possible. Your primary responsibilities will include: **Key Responsibilities:** * Conduct comprehensive assessments of referred members' needs and qualifications, using care management instruments and data/data audits to develop a plan to achieve case goals or address needs. * Identify high-risk factors and service needs that may impact member outcomes and collaborate with clinical case management or emergency intervention as necessary. * Organize and implement allocated care plan activities and monitor care plan progress. * Enhance Clinical Suitability and Quality of Care: + Utilize a comprehensive approach to discuss case management with case administrators, managers, Clinical Chiefs, or other healthcare projects to overcome barriers to meeting objectives and goals. + Present cases at case conferences to obtain multidisciplinary review and achieve optimal results. + Recognize and report quality of care issues through established channels. + Use negotiation skills to secure necessary choices and services to meet the member's benefits and healthcare needs. + Employ persuasive communication skills to ensure maximum member engagement and promote lifestyle/conduct changes to achieve optimal health. + Provide education, information, and support to enable members to make ongoing free clinical as well as healthy lifestyle decisions. + Assist members in effectively and knowledgeably participating with their provider in healthcare navigation. * Monitoring, Assessment, and Documentation of Care: + Utilize case management and quality management processes in accordance with regulatory and licensure rules and company strategies and methods. **Required Capabilities:** * 3+ years of experience in a health-related field * Strong communication and problem-solving skills * Ability to work in a fast-paced, dynamic environment * Proficiency in using care management instruments and data/data audits * Experience working with geriatric special needs, social health, and disability populations **Preferred Capabilities:** * CRC, CDMS, CRRN, COHN, or CCM certification * Federal health insurance and Medicaid experience * Managed care experience * Bilingual (English/Spanish; English/Creole) **Training:** * Bachelor's Degree or equivalent experience required **Compensation and Benefits:** * The regular compensation range for this job is: $19.52 - $40.90 * This pay range addresses the base hourly rate or base yearly full-time compensation for all situations in the job grade within which this position falls. * The actual base compensation offer will depend on various factors, including experience, training, location, and other relevant elements. * This position is eligible for an arenaflex reward, commission, or temporary incentive program in addition to the base compensation range listed above. **arenaflex Offers:** * A comprehensive benefits package, including clinical, dental, and vision benefits * A 401(k) retirement savings plan and a Representative Stock Buy Plan for eligible employees * A fully paid term life insurance plan and short-term and long-term disability benefits * Various wellness programs, training support, free development courses, and CVS store discounts and rebate programs with participating partners * Paid time off (PTO) or vacation compensation, as well as paid holidays throughout the calendar year * Number of paid holidays, sick time, and other time off are given in accordance with applicable state regulation and Company policies **Join arenaflex Today!** If you are a motivated and compassionate individual who is passionate about delivering exceptional customer service and making a meaningful impact in the lives of others, we invite you to apply for this exciting opportunity. Don't miss the chance to be part of a dynamic team that is revolutionizing patient care and support. Apply now to join arenaflex as a Case Management Specialist – Remote Customer Service Representative! Apply for this job