Major Responsibilities:

• Coordinates intake of cases on new and established assignments to expedite the Care Coordination process by facilitating the medical review process, verifying health plan eligibility, obtaining and assessing preliminary clinical and non-clinical data or needed additional data, determining appropriate case type, and triaging to the appropriate resource. Initiates and advances the Care Coordination plan, monitors status and advises regarding requirements, process and status.
• Researches, organizes and maintains the team's library of resources, guidelines and policies. Performs medical literature review searches to support the department.
• Facilitates implementation of new employer groups in collaboration with Onsite Nurse and sales staff. Insures adequate onboarding materials are available and interim reporting tools and processes are in place.
• Coordinates implementation of care gap outreach. Utilizes established criteria to generate lists of members requiring intervention and to process reminders according to established protocols. Verifies list accuracy and documentation of interventions.
• Assists in development and training of new employee department members in areas such as information system programs, individual health plans, and policies and procedures. Trains and educates provider office staff in referral/authorization process and procedures, contracts, standards, benefit plan limitations, and resource/contact liaisons.
• Develops and generates reports, as well as gathers, compiles and summarizes data for reporting and analysis by staff, management and external partners. Assists in monitoring, tracking and analyzing data.
• Coordinates development, ordering and stocking of materials to support Population Health activities. Initiates design based on branding guidelines and business needs.
• Oversees and/or maintains department files, binders, records, logs, etc. Identifies need of additional record keeping and establishes same.
• Performs a variety of routine and moderately complex administrative duties such as screening incoming telephone calls; open, sort and route incoming mail and faxes; typing letters, memos and reports; monitoring office equipment; purchasing/ordering of equipment or supplies.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 5 years of experience in population health management, utilization management, claims, health insurance processing, clinical or care management/quality environment.

Knowledge, Skills & Abilities Required:

• Proficiency in the use of ICD-10, CPT and HCPCS coding preferred.
• Knowledge of medical terminology.
• Ability to manage data systemically.
• Demonstrates organizational ability and attention to detail and accuracy.
• Advanced skills and knowledge in the use of Microsoft Office (Excel, PowerPoint and Word), Internet explorer and similar products.
• Excellent organizational, interpersonal, and communication skills (written and verbal) with the ability to effectively communicate with a variety of individuals.
• Exercises independent judgment and demonstrate excellent problem-solving skills while able to still work well within a team.
• Ability to demonstrate self-direction in prioritizing and accomplishing job responsibilities.
• Ability to maintain a high degree of confidentiality.

Physical Requirements and Working Conditions:

• Must be able to sit, stand, walk, lift, bend, twist, crawl, kneel, climb, and reach above shoulders at various times in each workday.
• Must be able to occasionally lift up to 10 lbs.
• Must be able to continuously use a keyboard.
• Exposed to normal office environment.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.