The Care 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:
(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
- Basic Computer Skills, 25 WPM (Microsoft Outlook, excel, word)
- Bilingual (English/Spanish) preferred
- Medical Terminology Certificate preferred
- 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.
Other Skills and Abilities:
- Good organizational skills
- Ability to reason and carry out instructions.
- Good interpersonal skills.
- Read, write and speak English fluently.
- File systematically.