Case Management Coordinator
Reports to: Department Manager
Department: Global Health Services
Calibrated Healthcare Network (CHN) manages over 11 million lives in over 8 states, partnering with industry leaders in the area of managed care. Our operating model features global workforce strategies, coupled with efficient technological solutions. We have a proven expertise in re-engineering complex managed care business processes to provide value to our esteemed partners. Our commitment to the evolution of healthcare is evident in our investment in research and development for the progression of dynamically enhanced technology to meet the needs of partners. The core suite of services includes Claims Adjudication, Benefits Setup, Member Enrollment and Eligibility Setup, Claims System Configuration, HCC Coding and MSO Development support.
The Calibrated Clinical Solution (CCS) global workplace is built on the concept of providing cost-effective care, enhancing population health strategies, and improving the quality of care. Calibrated Clinical Solutions deploys the use of proprietary software to create cost-effective workforce solutions constructed on the premise of collaboration technology. With our extensive domain of knowledge of managed care and dynamically enhanced technology, we have the capacity to create innovative solutions for our managed care and primary practice partners. Our core suite of services includes Medical Management, Utilization Management, Complex Case Management, and Population Health Management.
The Case Management Coordinator is responsible for the non-clinical case management support for an assigned population of members. The Case Management Coordinator acts a resource to the members, providers, RN Case Managers, and other members of the Care Coordination Team. The role is responsible for the overall non-clinical management of low risk members and transition of care interventions. The Case Management Coordinator is responsible for assisting members by organizing community resources to support member access.
- HS Diploma required
- MA or other healthcare related Certification preferred
- 1-year managed care experience preferred
- Previous utilization management experience preferred
- Core Competencies: Ethics and Values, Customer Focus, Action-Oriented, Learning on the Fly, Manage/Measure Work, Drive for Results, Priority Setting, Timely Decision-Making, Organizing, Functional and Technical Skills
- Computer Proficiency (General browsing proficiency)
- Capacity to interpret health plan/client specific benefit guidelines, and policies/procedures
Essential Functions of Job
- Able to perform functions of the UM Coordinator
- Responsible for member orientation, care coordination, self-management planning, health education, and health coaching for assigned group of members.
- Responsible for ensuring member correspondence as directed
- Responsible for adhering to the transition of care protocols for outreach, exchange of information, appointment scheduling, and care coordination.
- Responsible outbound calls for specialty referral tracking or care gap outreach based on client service level agreements; to include assisting dependent members with making specialist appointments, timely follow-up with adherence to appointment, timely request to specialist for exchange of information with primary provider, and accurate documentation of communication.
- Responsible for updating community resources, including health insurance, food, housing, and health information
- Able to facilitate communication and linkage to health care/social service systems
- Ensures the delivery of health information using culturally appropriate terms and concepts
- Making home visits to high risk members, as assigned
- Consistently meets or exceeds departmental productivity standards, quality standards, and IRR.
- Able to appropriately escalate clinical concerns
- Able to accurately navigate the client-based CM platform and accurately enter case data
- Demonstrate consistent and punctual attendance.
- Demonstrate behavior consistent with CHN mission, vision, and values.
- Adheres to Desktop Procedures and UM/CM Policies and Procedures
- Performs additional duties as assigned