The Care Management Coordinator is responsible for supporting the Clinical Care Manager by outreaching patients/caregivers, providers, Community Based Organizations (CBO), and others to help assist our highest need members into the Care Management (CM), Enhanced Care Management (ECM), and Disease Management (DM) programs. The position is responsible for gathering information on the patient’s strengths, challenges, needs, concerns, and barriers to care by conducting in person visits and telephonic interactions. The position works with the patient/caregiver, Clinical Care Manager, Primary Care Provider, Behavioral Health Specialist, and other members of the Interdisciplinary Care Team (ICT) to support the clinical team meet the patient’s individualized care plan and address unmet needs. This position coordinates the flow of information between the Care Management team and the patient/caregiver, provider, health plan, medical group, and other members of the patient’s health team. The position supports the coordination of patient care as instructed by the Clinical Care Manager and outlined in the care plan including the reinforcement of health education and disease management information; coordinating benefits such as authorizations, transportation and DME; and linking patients to community resources to address the Social Determinants of Health (SDoH) of the patient. The position is responsible for ensuring the CM team meets the contractual and regulatory requirements and timelines by maintaining accurate documentation and following up with the patient and provider as needed. In addition, this position will be assigned projects to support the department in meeting its regulatory and contractual requirements, such as running reports, data validation, quality checks and other projects. The position will assist with the communication and coordination between programs and maintain confidentiality when communicating patient information.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Supports and implements the organization’s vision, mission, and values.
2. Determines priorities and method of completing daily workload to ensure that all responsibilities are carried out in a timely manner.
3. Responsible for the time sensitive processes for initiating cases, managing referrals to the department, appropriate documentation, routing of information, performing computer data input, faxing, emailing, filing of confidential member information, and maintaining logs of activity, etc.
4. Assists with maintaining compliance on a minimum caseload of 50 cases a month. Documents efforts on EPIC, Care Management, and other platforms daily (coordination of care, medical record requests/outcomes, outreaches, maintains logs, eligibility, arranges transportation, communicates outcomes with Clinical Care Manager, etc.).
5. Engages patients to participate in Care Management, Enhanced Care Management, and Disease Management programs by outreaching, engaging, and promoting the programs to address unmet needs.
6. Completes telephonic calls and in person visits to conduct assessments with high-risk patients participating in the CM program.
7. Assists the clinical care team with caring out health interventions.
8. Conducts telephonic outreach calls to patients/caregivers, providers, care managers, regularly (daily, monthly, as needed) communicates and documents their progress towards their healthcare goals.
9. Consults and collaborates with the Clinical Care Manager to set up provider/specialist appointments and follow up on treatment plans.
10. Handles the incoming and outgoing calls to patients/caregivers and providers to coordinate care as identified in the care plan.
11. Initiates follow up calls to patients to administer screenings or confirm linkage to appropriate resources.
12. Provides general information to patients and providers about the CM and DM programs.
13. Sends Care Management letters, and informational materials to patients.
14. Assists with grievances to ensure effectiveness of the organization's process and quality improvement initiatives.
15. Must be able to manage diverse areas of understanding and interface effectively with all employees, employers, and QHC personnel and providers.
16. Coordinates and completes special projects delegated by the Quality leadership team.
17. Actively collaborates with other teammates to manage and meet the requirements of health center certifications including but not limited to the Patient Centered Medical Home (PCMH) and other accreditations as required.
18. Participates in the development and implementation of Quality goals and objectives and process improvement tactics. Ensures all goals and objectives are met timely and effectively.
19. Adheres to all company safety policy and procedures. Maintains a safe, clean and organized working environment.
20. Assists in preparation of audits.
21. Assists with orientation and training for new and existing employees as needed.
22. Understands HEDIS, STARs, and IHA AMP and assists patients with meeting quality measures.
23. Attends ongoing internal and external trainings and applies to daily work.
24. Complies with organizational policies and procedures.
25. Refers any potential quality of care issues identified to QI leadership.
26. Must be willing and able to work all business hours including evenings and weekends.
27. Performs all job functions in a professional and courteous manner. This includes answering all phone calls and e-mails timely and providing excellent customer service to internal and external clients.
28. Fosters and promotes a culture of service excellence and accountability.
29. Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to promote improved quality and continuity of care.
30. Assist in the compliance, accuracy, and timeliness of standards in accordance with CMS, NCQA, DHCS, Health Plan, and other federal regulations.
31. Performs all other duties as assigned.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION/EXPERIENCE:

1. High School Diploma/or High School Equivalency Certificate Education
2. Preferred associate degree Experience
3. Required: At least 6 months of experience in an administrative and customer service role in a health care/health services setting.

Preferred:

1. Bilingual: English/Spanish Speaker
2. One year of Medical Assistant experience. 6 months of experience processing authorizations at a FQHC setting.

LANGUAGE SKILLS:

Ability to read and interpret documents, such as policies and procedures, surveys, board minutes, routine mail, simple contracts, and procedure manuals. Ability to compose routine reports and correspondence.  Ability to speak effectively with employees and management.

MATHEMATICAL SKILLS:

Ability to calculate figures and amounts such as discounts, interest, proportions, percentages, and the ability to apply concepts of basic algebra, statistics, and geometry.

REASONING ABILITY:

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to apply common sense to daily situations that arise. Ability to make decision and execute timely to produce a positive outcome.

OTHER SKILLS AND ABILITIES:

1. Strong organizational skills, with the ability to manage several projects and teams at the same time.
2. Ability to work effectively with all levels of the organization and stakeholders, including communication with client and health plan executives in an utmost professional manner.
3. Ability to determine key issues and develop action plans.
4. Must be able to demonstrate a positive attitude and flexibility.
5. Demonstrates excellent communication skills, both oral and written.
6. Demonstrates proficiency in computer applications such as Microsoft Excel, Power Point, Word and Outlook.
7. Displays positive outlook on the job and promotes professional behavior always.
8. Ability to organize and prioritize work with minimum supervision.
9. Ability to manage time efficiently and follow through on duties to completion.
10. Understands and commits to maintaining the highest level of confidentiality.
11. Demonstrated ability to build a positive rapport and respect of patients, staff, colleagues, and other external contacts.
12. Excellent problem-solving skills required, including creativity, resourcefulness, timeliness, and technical knowledge related to analyzing and resolving clinical problems.
13. Sensitivity to needs of culturally and linguistically diverse patient and employee population.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands to finger, handle or feel and reach with hands and arms. The employee frequently is required to stand, walk, and sit. The employee is occasionally required to climb or balance, stoop, kneel, crouch, or sit. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 30 pounds. The employee is occasionally required to ascend and descend one flight of stairs. Specific vision abilities required by the job include close vision, color vision, and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is often low. However, there are many times when there is a high ambient background noise of phones and multiple conversations. Must be able to screen out the background noise to concentrate on the work at hand.