Sr. Care Management Service Coordinator, Commercial Care Management at Tufts Health Plan

Posted in Other 5 days ago.

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Type: Full Time
Location: Watertown, Massachusetts





Job Description:

We enjoy the important work we do every day on behalf of our members.

Job Summary

Under the general direction of the Care Management Team Manager, the Transition Coordinator is responsible to telephonically support member transition of care episodes pre-operatively, following hospital or ED services, identified through predictive modeling, or as determined by department needs.. The Transition Coordinator is a key member of the care management team who works independently to contact assigned member for telephonic outreach, screening and support with care coordination needs. The Transition Coordinator functions as a key customer service representative for the department representative for both internal and external customers. The Transition Coordinator is also responsible for timely triage and referral processes, tracking logs, key account support, and other administrative functions as determined by the department.

Job Description

Member Transition Support
Responsible for short term follow-up screenings with members discharged from post-acute hospital and emergency department settings, as well as members identified by other referral sources. Activities include, but are not limited to:
- Independently assess members for the transition program s and gain solid understanding of their transition needs
- Understand, support, and address member, family and/or caregiver needs and concerns, including unique and non-traditional life circumstances
- Track and manage member needs within the defined intervention period for the member specific population, complete follow-up responsibilities within required timeframe
- Appropriately recognize, communicate, and escalate identified issues to RN Care Manager or Team Manager for timely intervention/resolution
- Provide education and coaching to the member, family, and/or caregiver about follow up care, and health insurance benefits which could also include mailing of letters and/or educational materials
- Ensure timeliness in coordination of health care services. Assist members with scheduling appointments, tests, screenings, and transportation.
- Collaborate with RN Care Manager or Team Manager on external community services or transportation needs; as well as interface with external community agencies to schedule services or provide resource information to the member/ care giver to support self -management
- Ability to problem solve, research, and work independently
- Assist in execution of special projects and outreach campaigns,
- Understands and achieves the defined benchmarks and operational measures for Transition Coordinators to demonstrate proficiency in responsibilities which contribute to Department and company business goals
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Supports the Clinical Transition team as needed to confirm discharge dates and close events timely, works as a liaison to UM Coordintator team, andattaches clinical documentation as applicable
- Serves as essential liaison and link between members and care managers

Department Administrative Support
- Daily referral and triage tasks to meet the needs of CM department, with focus on ability to keep management team updated in timely manner
- Has solid working knowledge and provides daily updated information related to triage volume, Team ET Schedule, capability based on caseloads, and account specific-information
- Compiles and tracks outcomes, makes recommendations for process improvement
- Manages Referrals from the PC Mailbox, PC voicemail, and Right fax system
- Support and maintain required department tracking logs and registry lists
- Understand and perform key administrative functions for key accounts which may be related to attribution logs, daily admission reviews, and tracking of defined information
- Solid understanding of key systems for appropriate documentation and dissemination of information (TAHP, Macess, CCMS, MedHOK, IBM connections platforms)
- Interfaces with multiple internal departments and researches issues as needed to support management team and functions as liaison to staff, administration, internal and external stakeholeders, including community organizations
- Through relationship development, is able to familiarize and articulate benefits of CM transition program to internal and external customers and encourage referrals
Performs case documentation according to Department standard including but not limited to timely completion of daily tasks, timely opening and closing of transition of care cases, and same day case data entry.
Supports program reporting need with accurate documentation in identified trackers; and provides coverage associated with member triage and referral source management at the direction of the Team Manager. Ability to cross train to support the department as needed
Identifies, documents, and refers potential quality occurrences to the Team Manager for submission to Clinical Quality Improvement Department
Attends 1:1 meeting with Team Manager a minimum of one hour every two weeks, as well as, attends regularly scheduled Department, Company educational or other required meetings as necessary.
Maintains compliance with Corporate Privacy and Communication Policy, standards for managing voice mail and will be available by phone during normal business to both internal and external customers
Member Transition Support
Responsible for short term follow-up screenings with members discharged from post-acute hospital and emergency department settings, as well as members identified by other referral sources. Activities include, but are not limited to:
- Independently assess members for the transition program s and gain solid understanding of their transition needs
- Understand, support, and address member, family and/or caregiver needs and concerns, including unique and non-traditional life circumstances
- Track and manage member needs within the defined intervention period for the member specific population, complete follow-up responsibilities within required timeframe
- Appropriately recognize, communicate, and escalate identified issues to RN Care Manager or Team Manager for timely intervention/resolution
- Provide education and coaching to the member, family, and/or caregiver about follow up care, and health insurance benefits which could also include mailing of letters and/or educational materials
- Ensure timeliness in coordination of health care services. Assist members with scheduling appointments, tests, screenings, and transportation.

Tufts Health Plan is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you d like more information on your EEO rights under the law, please click here.


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