The Care Management Care Coordinator functions as an integral part of the Care Management department. They are a member of a team that supports the day-today functions of a complex medical network and activities include, but not limited to, outreach functions, assignment of care management cases, mailbox communication and referrals, other. This individual must be able to plan, organize, and prioritize work to ensure completion in a timely manner. The Care Coordinator functions as a key contact and department representative both to internal and external customers of the care management department through verbal and written communications. Under the administrative direction of the Supervisor of Care Management Service Operations, the Care Coordinator performs activities that support the clinical, business and program related work of the Care Managers (CM) and the management team.

Key Responsibilities/Duties - What You Will Be Doing

• Care Coordination:
  • Initiates outreach cycle and documents in electronic record and/or member referral status.
  • Facilitates member engagement.
  • Collaborates with Care Managers in assisting members who are hard to reach, refuse or disenrolling.
  • Responds to and triages requests in Care Management mailbox.
  • Assigns cases to care management team.

• Support General Case Management Functions
  • Document member-specific program participation in CaseTraker, MedHok and Jiva. Accurately enter data into assigned care management databases.
  • Independently researches remote Care Manager’s inquiries related to member eligibility, participation in internal THP programs and status of ongoing consultations with other THP departments.
  • Makes outreach calls to members who transitioned from an Emergency Department (ED) to home or left AMA who are low acuity and risk.
  • Assist Care Managers (BHCM) in finding engaged members appointments.
  • Assist in calling members with HEDIS identified needs.

• Perform complex administrative duties, adjunct to the role of the Clinical Manager with minimal supervision:
  • Accurately enter data into MedHok, CastTraker and/or Jiva, and other databases and tracking programs
  • Complete clerical and Right Fax tasks as required
  • Effectively prioritize tasks and ensure deadlines are met
  • Employ multi-tasking skills when multiple deliverables are due

• Support Clinical Initiatives and Programs:
  • Supports the development and implementation of programs related to quality measures
  • Participate in outbound calling programs to members with potential quality triggers

• Other duties and projects as assigned.

 

Qualifications - What You Need To Perform The Job

Education, Certification and Licensure

• High School degree required.
• Associate degree in business and/or related administrative or clinical field is highly desirable.

Experience (minimum years required):

• Experience in a health care environment, especially in managed care is highly desirable.
• For internal applicants, experience required in MedHok, CaseTracker and/or Jiva.

Skill Requirements

• Proficiency required in Microsoft Suite and other software applications desirable.
• Medical Terminology comprehension required.
• Familiarity with mental health issues helpful.
• Complexity and Interpersonal Skills:
  • Work independently and cooperatively as a team member across multiple levels within the organization.
  • Must have a commitment to excellence in customer service.
  • Must have well developed written and verbal communication skills.
  • Ability to identify emergency situations and follow the established protocol.
  • Ability to handle multiple demands and must be able to balance multiple priorities within set protocols and procedures.
  • Strong organizational skills to be able to handle a routine workload and multiple tasks while maintaining excellent customer service.
  • Ability to increase workload and be flexible with coverage responsibilities in order to meet strict department deadlines.
  • Strong knowledge of Clinical Services’ departments and THP organizations in order to accurately and quickly assess situations and direct internal and external customers appropriately.
  • Must project a professional and mature demeanor and accept direction as needed.
  • Must consistently exercise sound decision-making skills as necessary.
• Regard for confidential data and adherence to corporate compliance policy.
• Ability to enter data and type the information received during a telephone conversation.
• Must be able to exercise sound judgment as necessary and to work and communicate with customers in a telephonic office and remote environment.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

• Fast paced office environment handling multiple demands independently.
• A cubicle-based hoteling and remote work environment, which presents challenges to maintaining focus on the work while exposed to other voices and work sounds.
• Ability to carry 5 – 25 pounds of materials from one business area to another, approximately a distance of 100 yards.
• Digital and manual dexterity required for keyboard along with ability to work on a display monitor for long periods of time.
• Overtime and flexibility of hours may be required on an as needed basis.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R7037

Posted On: Wednesday, September 6, 2023