Care Coordinator – Primary Care Clinic
Care Coordinator Job Summary:
*** This is a Full-Time, Benefits Available, CONTRACT position expected to last 6 months or longer ***
Care Coordinator Background:
- Coordinates follow-up care plans by scheduling needed appointments or enrolling member in related programs
- Assesses member compliance with medical treatment plans, identifying any barriers and coordinating resolution to ensure that members receive appropriate care, at the appropriate level, in a timely manner
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
- Provides information regarding network providers or general health plan or program information when requested
- As needed, administratively assist with the review of complex cases
- In conjunction with case management nurse and providers, makes recommendations to adjust or modify treatment plan and/or determines need for additional services
- Serves as a liaison between the Medical Management departments (CM/UR/QI, etc) and Health Plan Operations or other internal departments
- Investigate inquiries, follow up on them, and document actions required to service inquiry
- Assists customers in navigating relevant websites and encourage and reassure them to become self-sufficient
- Identifies and refers members to appropriate local, state or federal programs
- Requires an education level of at least a high school diploma or GED; Associate’s or Bachelor’s degree is a plus.
- Prefers, but does not require, a Medical Assistant certification (CMA or RMA).
- Requires exceptional phone / customer service skills, as well as very strong computer user skills.
- At least 3-5 years’ Care Coordination experience, preferably in home health or provider setting, or other healthcare support role with heavy computer & phone use.
- Requires 1 or more years at a Managed Care Organization (Health Plan, IPA/Medical Group, HMO, TPA/MSO, etc).
- Requires basic to intermediary familiarity with Medical terminology (1-3 years direct experience).
- Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
- Knowledge of health care delivery system, Medicaid/Medicare and related state programs is required.
- Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
- Must have a minimum of 40 wpm typing with a high level of accuracy.
- Strongly prefer Bilingual in English and Spanish.