Job Description:

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

Job Summary

JOB SUMMARY:

Under the direction of the Accountable Care Manager, the Care Coordinator (CC) for Unify utilizes critical thinking and problem-solving skills to contribute to an integrated care team to deliver coordinated, quality care for a dually-eligible members under the age of 65. The Care Coordinator directly develops relationships and interfaces with providers, other members of the care team, members and their caregivers in identifying risk factors, implementing care plans and coordinating care to prevent avoidable health care utilization and optimize member outcomes. The Care Coordinator will collaborate with a team of RN care managers, BH care managers, community health workers, peer supports and long term services and supports coordinators to ensure that members receive the highest quality of care at the right time and in the right locatio

Job Description

KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS*
Member Outreach and Team Collaboration

- Performs member outreach through varying methods to encourage member engagement with their care team
- Manages and coordinates care for low acuity members, primarily through telephonic outreach
- Provides care coordination across multiple settings
- Participates in care planning and collaborates with the care team to discuss ongoing care, offer potential solutions to clinical and/or social barriers and serves as a facilitator for future needs of members
- Coordinates care with other medical providers: assist with making appointments, reminding client of appointments, obtaining clinical record information and communicating with other providers
- Coordinates with the Long Term Services Support Coordinator (LTS-C) in the co-management of members with LTSS needs
- Ensures needed preventative healthcare provided on schedule
- Participates in case reviews and care team huddles

- Provides support and notifies the care team regarding changes in: behavior, nutrition, exercise, substance use, medication compliance, and other issues as related to the established care plan
- Implements care plans and supports members to develop the skills needed to successfully live and work as independently as possible
- Identifies service delivery gaps and barriers, and identifies referrals and interventions to remove socioeconomic barriers
- Assists the member in navigating and accessing appropriate services and programs and works with the member to eliminate duplication of services; educates members as needed
- Documents appropriately and timely in the care management information system
- Collaborates with care team in coordination of care and care planning during transitions of care
- Participates in risk management activities, including identifying and communicating issues

Administrative Support

- Supports the integrated care team with appointment scheduling, resource referral and member telephonic outreach

- Responsible for reviewing cases for hard to reach members to enable care team members to perform direct outreach.
- Participates in risk management activities, including identifying and communicating issues of risk in a timely manner

- Coordinates care with other medical providers: assist with making appointments, reminding client of appointments, obtaining clinical record information and communicating with other providers
- Links with case management services to assist with access to home-based services and benefits, including LTSS
- Responsible for tracking members and escalating risks in the MassHealth redetermination process

- Generates reports on patient data through relevant computer systems/applications
- Maintains current knowledge of community resources for referral and linkage to meet member needs
- Performs other duties as assigned

Requirements

JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

EDUCATION: (Minimum education required)
- High School Diploma or equivalent
- Associates degree

EXPERIENCE: (Years of experience)
- Minimum 2 years related experience in a health care environment
- Ambulatory care, high-risk population, and/or transitions of care experience

SKILL REQUIREMENTS: (Include interpersonal skills)
- Demonstrates strong interpersonal and conflict resolution skills
- Strong understanding of medical terminology
- Intermediate level of proficiency in Microsoft Office and documentation in electronic medical records
- Knowledge of Medicare and Medicaid, benefits and community resources
- Bilingual language skills strongly preferred

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

*Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment. Ability to learn and apply company policies consistently, seeking out guidance when necessary, is required.

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!.

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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