Operations Specialist – Care Management, Member Services

CareSource

. Support care plans, including ordering member services such as equipment, supplies, transportation and personal care .

Posted 10/7/2026full-timeQueens • New York • United StatesMid-LevelSenior💰 $41,200 - $66,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in managing member services, including care plan support and service intake, while adhering to HIPAA regulations. Bilingual communication skills in Spanish, Russian, or Chinese enhance interactions with diverse member populations.

Highest-signal resume keywords

Bilingual CommunicationKnowledge of Medicare and Medicaid RegulationsMicrosoft Office ProficiencyAttention to DetailCritical Thinking Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Service Intake ProcessingAuthorization ProcessingMedical Billing TerminologyDocument VerificationCare Plan Support

Soft Skills

Excellent Verbal CommunicationProfessional Phone EtiquetteConflict ResolutionAdaptabilityMultitasking

Industry Keywords

HIPAA ComplianceHealthcare EnvironmentGeriatric CareMember ServicesRegulatory Agency Requirements

About the role

Key responsibilities & impact

Support care plans, including ordering member services such as equipment, supplies, transportation and personal care
Process service intake from members
Assist Nurse Care Managers with member interactions
Process authorizations
Answer incoming calls and make outgoing calls as requested
Review member care management survey results and identify issues requiring follow-up
Order services and supplies and ensure timely delivery
Provide backup support to Member Services Representatives, including inbound and outbound calls
Create a welcoming environment for patients, visitors and customers
Respond to customer requests and concerns in a timely manner
Work closely with the Clinical Team
Verify documents appropriately
Adhere to HIPAA and state requirements and regulations
Perform other related duties as requested

Requirements

What you’ll need

High School or GED required
Bilingual (fluent in Spanish, Russian or Chinese) required
Fluency (speaking, reading, and writing) in multiple languages as determined by needs of business is required
Knowledge of Medicare and Medicaid regulations
Ability to utilize Microsoft Office Products
Knowledge of federal, state, local and regulatory agency requirements related to the department and position
Ability to integrate age-specific requirements with individual developmental, mental, social and cultural needs for geriatric members
Excellent verbal and written communication skills
Ability to handle conflicts professionally
Professional phone etiquette
Proper use of grammar
Ability to work in a fast-paced environment
Adaptability to a constantly changing environment
Attention to detail
Ability to multitask
Ability to work independently and with a team
Critical thinking and listening skills
Decision-making and problem-solving skills
Familiarity with the healthcare environment (Medicaid/Medicare) preferred
Previous medical billing/terminology experience preferred
Prior field experience working with therapists/other licensed medical professionals preferred
No licensure or certification required

Benefits

Comp & perks

Potential bonus tied to company and individual performance
Substantial and comprehensive total rewards package
Employee total well-being support
Equal opportunity and belonging-focused workplace