Care Guide Plus

Full - Time: 40 Hours Per Week

1st Shift: 8am - 4:30pm

Monday - Friday

Remote with onsite requirements as needed

Summary

The Care Guide Plus, under the direction of the licensed professional, will be responsible for supporting licensed personnel in care management efforts. A Care Guide facilitate the initial point of contact to support care management for all pediatric populations as assigned. This position facilitates short-term care plans and works collaboratively with the Care Management (CM) team to deliver high quality of care coordination to patients/families/caregivers

Responsibilities

• Participates in the Care Management model as a working partner with providers, facilities, care managers, social workers, pharmacists, and other professional staff and supports Care Management (CM) clinical staff in processing referrals to the CM program.
• Supports patient outreach efforts and outreaches to patients/families/caregivers to engage in care management. Verifies and/or secures insurance coverage, individual demographics, referring physician and network status of the provider for the attributed population.
• Facilitates timely completion of patient assessments/screenings and remediates immediate and acute gaps in care and access issues under the direction of licensed CM staff. Connects patients to licensed CM when the patient's needs indicate a higher level of coordination.
• Maintains a caseload of patients for non-licensed follow-ups, adhering to communicated productivity metrics. Accurately and efficiently documents patient data and communications in accordance with compliance and regulatory requirements.
• Assists with bi-directional communication between primary care providers, specialists, pharmacies, ancillary services, and payers to facilitate timely exchange of information. Facilitates needed services for the patient/family/caregiver and exchanges information with the patient’s care team to support the patient’s care.
• Assists in the coordination of covered services and connection to resources and provides information to patients/families/caregivers related to insurance payer requirements, services and benefits.
• Participates in discharge planning activities with inpatient facilities and payers to support safe discharge placement and prevent unplanned or unnecessary readmissions, ED visits or adverse outcomes. Ensures patient access to post discharge services as specified in the discharge and transition plan. Facilitates clinical hand-offs between discharging facilities and other providers involved in the care and treatment of patients.
• Assists patients with filing grievances and appeals, supporting their point of view.
• Other duties as assigned.
  
  

Other Information

Technical Expertise

• Experience working in healthcare and knowledge of medical terminology required.
• Experience with healthcare coordination in a managed care environment, homecare or community agency is preferred.
• Demonstrates professional, appropriate, effective, and tactful communication skills, including written, verbal, and non-verbal.
• Excellent organizational skills with the ability to effectively prioritize multiple tasks and coordination completion in a timely and accurate manner.
• Proficiency in MS Office [Outlook, Excel, Word] or similar software is required. Epic software or similar EMR software is preferred.
  
  

Education And Experience

• High School Diploma or equivalent is required; Associates Degree in related field is preferred.
• Completion of state approved Medical Assistant Program, EMT, Paramedic and/or Certified Community Health Worker program is required.
• Basic Life Support (BLS) certification from the American Heart Association is required.
• Experience in high volume payer, healthcare inbound/outbound customer service and/or care coordination setting preferred.
• A minimum of 3 years of clinical experience in healthcare required. Pediatric ambulatory, care management and/or health plan experience is preferred.
• Years of experience supervising: None.
  
  

Full Time

FTE: 1.000000

Status: Remote