Coordinator - Care Management (Remote)

Position Summary/Position

Under the general supervision of the Care Management (CM) Manager and direct supervision of the CM Coordinator Supervisor, the CM Coordinator is responsible for advocating, facilitating and supporting care management activities.

Major Functions (Duties and Responsibilities)

1. Responsible for assisting Members with care coordination in respect to referral process such IPA for Durable Medical Equipment (DME), home health, and Specialist needs.
2. Responsible for assisting with the referral process by contacting providers by phone, fax, or email to request additional medical information as needed.
3. Responsible for assisting the Care Managers in the management and coordination of care of Member identified with care management conditions.
4. Responsible for facilitating Member care to ensure that a continuity of care letter of agreement (LOA) is executed when appropriate.
5. Collaborates on Member’s care issues with other team members and consults with NCM or CM supervisor to ensure that appropriate treatment plan is followed, thoroughly and promptly.
6. Responsible for processing and coordinating divorces, disenrollment, transportations, and language interpretation as needed and applicable.
7. Assists with contact calls for monthly HRA pull, i.e., Complex Case Management and assisting with coordinating the members overall care as needed.
8. Responsible for identifying HEDIS gaps and contacting the member to address these gaps.
9. Responsible for covering Cisco ACD Queue telephone lines and Phone queue.
10. Assists with the coordination of access issues with PCP offices, specialists, radiology services and ancillary services such as PT, OT, speech therapies.
11. Ensures documentations is accurate and in compliance with regulatory requirements and accreditation standards.
12. Consults with assigned nurses for clinical assessment and decision prior to taking action that are clinical in nature.
13. Performs any other duties as assigned or required to ensure Health Plan operations are successful.
14. Participates in Medical Services staff meetings or other activities as needed
15. Ensures the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance including attending annual compliance training.
16. Promotes a positive and collaborative working environment within the CM Team.

Experience Qualifications

Two (2) years customer service experience in medical clinics, hospitals, or IPAs.

Preferred Experience

Managed care setting experience preferred.

Education Qualifications

High school diploma or GED required.

Preferred Education

Associate's degree or Bachelor’s degree from an accredited institution preferred.

Professional Certification

Medical Assistant Certification preferred.

Knowledge Requirement

Knowledge of Utilization Management including referral process, ICD-10 and CPT codes preferred. Knowledge of utilization management process and care coordination in HMO or managed care setting. Knowledge of Medi-Cal, and Medicare managed care. Understanding of and sensitivity to multi-cultural community.

Skills Requirement

Excellent written and verbal communication and interpersonal skills. Strong organizational skills, typing 45 words per minute, proficient in Windows applications. Experience in data entry.

Abilities Requirement

Team culture is a must. Telephone courtesy and high degree of patience.

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.