Coordinator - Care Management

Position Summary/Position

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.

This is a Bilingual (English/Spanish) position. The team member in this role must take a language proficiency assessment and receive a minimum score of 9.

Major Functions (Duties and Responsibilities)

1. Responsible for assisting Members with care coordination in respect to referral process such IPA for Durable Medical Equipment (DME), home health, and Specialist needs.
2. Responsible for assisting with the referral process by contacting providers by phone, fax or email to request additional medical information as needed.
3. Responsible for assisting the Care Managers in the management and coordination of care of Member identified with care management conditions
4. Responsible for facilitating Member care to ensure that a continuity of care letter of agreement (LOA) is executed when appropriate.
5. 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.
6. Responsible for processing and coordinating divorces, disenrollment, transportations, and language interpretation as needed and applicable.
7. Responsible for completing first
8. Assists with contact calls for monthly  HRA  pull, i.e. Complex Case Management and assisting with coordinating the members overall care as needed.
9. Responsible for identifying HEDIS gaps and contacting the member to address these gaps.
10. Responsible for covering Cisco ACD Queue telephone lines
11. Phone queue.
12. Assists with the coordination of access issues with PCP offices, specialists, radiology services  and   ancillary services such as PT, OT, speech therapies.
13. Ensures documentations  is accurate and in compliance with regulatory requirements and accreditation standards.
14. Consults with assigned nurses for clinical assessment and decision prior to taking action that are clinical in nature.
15. Participates in Medical Services staff meetings or other activities as needed
16. Promotes a positive and collaborative working environment within the CM Team.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Bilingual (English/Spanish) - written and verbal skills required.

Two (2) years customer service experience in medical clinics, hospitals, or IPAs.

Preferred Experience

Managed care setting experience preferred.

Education Qualifications

High school diploma or GED required.

Preferred Education

Associate's degree or Bachelor’s degree from an accredited institution preferred

Professional Certification

Medical Assistant Certification preferred.

Professional Licenses

Drivers License Required

Knowledge Requirement

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.

Skills Requirement

Excellent written and verbal communication and interpersonal skills. Strong organizational skills, typing 45 words per minute, proficient in Windows applications. Experience in data entry.

Abilities Requirement

Team  culture a must. Telephone courtesy. High degree of patience.

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

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.

Work Model Location

Physical Requirements