What are the responsibilities and job description for the Coordinator - Care Management position at Inland Empire Health Plan?

Overview

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

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.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary.
Hybrid schedule.
CalPERS retirement.
State of the art fitness center on-site.
Medical Insurance with Dental and Vision.
Life, short-term, and long-term disability options
Career advancement opportunities and professional development.
Wellness programs that promote a healthy work-life balance.
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Key Responsibilities

Responsible for assisting Members with care coordination in respect to referral process such IPA for Durable Medical Equipment (DME), home health, and Specialist needs.

Responsible for assisting with the referral process by contacting providers by phone, fax, or email to request additional medical information as needed.

Responsible for assisting the Care Managers in the management and coordination of care of Member identified with care management conditions.

Responsible for facilitating Member care to ensure that a continuity of care letter of agreement (LOA) is executed when appropriate.

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.

Responsible for processing and coordinating divorces, disenrollment, transportations, and language interpretation as needed and applicable.

Assists with contact calls for monthly HRA pull, i.e., Complex Case Management and assisting with coordinating the members overall care as needed.

Responsible for identifying HEDIS gaps and contacting the member to address these gaps.

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.

Ensures documentations is accurate and in compliance with regulatory requirements and accreditation standards.

Consults with assigned nurses for clinical assessment and decision prior to taking action that are clinical in nature.

Performs any other duties as assigned or required to ensure Health Plan operations are successful.

Participates in Medical Services staff meetings or other activities as needed

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.

Promotes a positive and collaborative working environment within the CM Team.

Qualifications

Education & Requirements

Two (2) years customer service experience in medical clinics, hospitals, or IPAs
Managed care setting experience preferred
High school diploma or GED required
- Associate's degree or Bachelor’s degree from an accredited institution preferred
Medical Assistant Certification preferred

Key Qualifications

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
Excellent written and verbal communication and interpersonal skills
Strong organizational skills, typing 45 words per minute, proficient in Windows applications
Experience in data entry
Team culture is a must
Telephone courtesy and high degree of patience
Communication with IEHP Members, which includes intensive telephone use, basic computer knowledge and word processing/data entry skills including computer keyboard and screens, distribution of reports, filing and copying of records and/or correspondence
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location

Hybrid

Pay Range

USD $23.98 - USD $30.57 /Hr.

Salary : $24 - $31

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Coordinator - Care Management

What are the responsibilities and job description for the Coordinator - Care Management position at Inland Empire Health Plan?

Overview

Additional Benefits

Key Responsibilities

Qualifications

Work Model Location

Pay Range

What is the career path for a Coordinator - Care Management?

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