• Case Management Coordinator,I

    Location US-CA-Commerce
    Job ID
    2018-6910
    Category
    Managed Care
  • Overview

    This position will provide support to Case Management Department and assist with case and care management.  Acts as a liaison for case managers to assist with obtaining the HRA (Health Risk Assessments), gathering of pertinent healthcare information, and follow-up on specialty/ancillary services.  The Coordinator will generate/manage the daily census, post discharge calls, and facilitate transitions of care.  Responsible for processing and tracking referrals including interdepartmental referrals to AltaMed Senior Programs.  Serves as an associate and resource to patients, providers, staff, and external customers regarding policies, benefits, and care coordination.  Participates in and provides report data as required.

    Responsibilities


    1. Creates, generates and maintains reports as requested or on a scheduled basis.

    2. Coordinate member/patient inquiries regarding the authorization process and other issues with applicable internal/external functions.

    3. Enters of all requests into the referral tracking system, coordinates authorization request as directed by the Case Manager for the Case Management Department

    4. Maintains up-to-date knowledge about payer sources.  Knowledgeable about the regulations regarding these various payer sources.

    5. Facilitates communication with CCS authorizations, third-party payers and clinical staff to ensure authorization of services.

    6. Processes all referral requests from the physicians according to department policy and procedure.

    7. Coordinates and assists with patient appointments as needed and notifies patient of authorization status.

    8. Obtains consultation reports from specialists and submits to provider for review.

    9. Assists with program specific goals and objectives as directed by Manager of Case Management.

    10. Reviews Inpatient Census on a daily basis for Special Needs Plan (SNP) Senior Persons with Disability (SPD) members on a daily basis and reviews pertinent information with appropriate Nurse Case Manager.

    11. Obtains Health Risk Assessment forms from Health Plan partners

    12. Has primary responsibility for gathering relevant information for the SNP/SPD member population during care transitions and submitting to the High Risk Nurse Care Manager for review and completion.

    13. Creates and assigns cases from Tier Report as directed by Manager of Case Management.

    14. Maintains caseload current for Low Risk care coordination.

    15. Completes Transition of Care calls and document in appropriate cases.

    16. Perform all other related duties as assigned. 


     


    Measurements of Success:


    I. MEETS PERFORMANCE REQUIREMENTS



    • Meet the established Performance & Productivity Targets.  Department’s Performance Metrics.

    • Effective time management demonstrated by meeting all regulatory and health plan requirements. Measurements, 100% of audits completed and documents submitted within the required time line.  No more than three CAPS per health plan per audit.

    • Managing multiple priorities, demonstrated by ease and productivity to transition between multiple tasks.  Measurement, Department Performance Measure.

    • Team player, measured through assisting co-workers with their workload as asked by the Manager/Supervisor/Lead or others and have completed cross-training to support when necessary and in absence of co-workers performing similar functions.

    • Basic analytics understanding to track and manage and report outcomes of assigned caseload.

    • Highly effective communication with members, external constituents, and internal stakeholders.  Measurement, Member Satisfaction with Case Management and internal customer feedback.


    II.  EXCEEDS PERFORMANCE REQUIREMENTS



    • All items listed under “Meets Expectation,” and:

    • Problem solving skills demonstrated by identification, recommendation, and implementation of tactics and approaches to improve productivity and team work.

    • Taking initiations demonstrated by consistent and active offer participation to be a positive change agent, to problem solve, identify and offer suggestions to improve outcomes in Case Management, and to assist others as needed.

    • Leading by example.  Be the role model in offering supportive care to patients, and consistently meet needs of the external and internal customers.

    Qualifications


    1. High School diploma plus a minimum 2 years experience working in a healthcare environment; knowledge of prior authorization and case management regulations governing Medi-Cal, Commercial, Medicare, CCS, and other government and commercial programs.

    2. Minimum 2 years experience in a managed health care environment, preferably IPA, HMO, or Health Plan.


    1. Bilingual English/Spanish preferred.

    2. Medical Billing Certification preferred.

    3. Medical Assistant experience strongly preferred.

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