What are the responsibilities and job description for the Care Management Coordinator position at Independent Living Systems?
About the Role:
As a Care Management Coordinator at Independent Living Systems (ILS), you will be responsible for ensuring that our members receive the highest quality of care. ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. The Care Management Coordinator is responsible for efficiently processing tasks related to denials, reductions, terminations, and suspensions of services to generate notices of adverse benefit determinations, while ensuring strict compliance with the timeline requirements specified in the SMMC contract.
Minimum Qualifications:
- Associate's degree in nursing, Healthcare Administration, or related field.
- 2 years of experience in care management or related field.
- Strong communication and interpersonal skills.
- Ability to work independently and as part of a team.
- Excellent organizational and time management skills.
- Relevant experience may substitute for the educational requirement on a year-for-year basis
Preferred Qualifications:
- Bachelor's degree in Nursing, Healthcare Administration, or related field.
- Experience working with electronic medical records (EMR) systems.
- Certification in care management (CCM).
Responsibilities:
- Screen and manage the UM DRTS queue to ensure timely completion of notice of adverse benefits determinations (NADBs) letters by prioritizing tasks according to the stratification.
- Generate the NABD letters within the eCare system and ensure NABD letters are uploaded to the designated outbound folder within the ILS drive.
- Complete DRTS report daily to reflect and account for all NABD letters produced during the day.
- Identify and discuss any potential benefit determination rationale discrepancies with the Medical Director and/ or the Director, CM Oversight. Complete corrections as appropriate.
- Coordinate with care managers during the processing of voluntary reduction, termination, and suspension requests, verifying that the signed attestation by the member or authorized representative is appropriately documented in the member's records. Adheres to organizations and departmental policies and procedures.
Skills:
As a Care Management Coordinator, you are responsible for efficiently processing tasks to generate notices of adverse benefit determinations, while ensuring strict compliance with the timeline requirements specified in the SMMC contract. Your ability to work independently and as part of a team will be essential. Additionally, your experience with electronic medical records (EMR) systems will be beneficial in this role.
