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We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
Care Anywhere--Care Coordinator
Position Summary:
The Clinical Coordinator manages a case load of field-based and clinic providers and extenders to ensure high quality services and care coordination activities are delivered to high risk members.
The Care Coordinator is responsible for UM/CM Coordinator functions as defined below:
General Duties/Responsibilities:
(May include but are not limited to)
Review Daily Census for new Admissions
Obtain medical records from Provider offices, hospitals and SNF’s
Attach medical records to authorizations
Enter referral requests/authorizations in system
Monitor Fax Folders
Monitor task lists in EHR
Post discharge scheduling of appointments
Follow up scheduling and re-scheduling of no-show appointments
Assist NP team with visit preparation needs
Appointment reminders to members
Assign members to NP in EHR
Provide needed documentation to NP for visits each day
Direct inbound calls from members/family related to medication refills
Assist in Hospice Enrollments
Complies with tasks assigned by nurse and, as appropriate, documents accordingly.
Maintains documentation on members contacted.
Assists with COC’s
Notifies NP/nurse If members appear to be non-compliant or there appears to be a change in condition
Assists with outreach activities to members in all levels of Case Management Programs.
Assists with maintaining and updating member’s records
Assists with mailing or faxing correspondence to PCP’s, Specialists, related to, as needed.
Recognizes work-related problems and contributes to solutions.
Meets specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs).
Works with outside vendors to provide appropriate care needs for members
Maintains confidentiality of information between and among health care professionals.
Other duties as assigned by CM Manager or Director of Case Management.
Communication with multidisciplinary teams
Covering for other team members when needed, ie PTO, sick time
Minimum Education and/or Experience:
High school diploma or general education degree (GED) required; with one year related experience and/or training; or equivalent combination of education and experience. No licensure required.
Knowledge of ICD9 and CPT codes
Knowledge of Managed Care Plans
Experience entering referrals and prior authorizations
Knowledge working in Access Express/Portal, epic, essette (not mandatory)
Good oral, written and telephone skills
Skills and Abilities:
Language Skills: Ability to read and interpret documents and follow up on orders from NP’s/MD’s. Ability to read and follow instructions and procedure manuals. Ability to write routine reports and correspondence. Communicates effectively using good customer relations skills.
Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.