Job Title: Member Care Coordinator
Contract Duration: 6 months, possible extension/conversion
Location: Raton, NM or surrounding area
Work Arrangement: Onsite
Pay Range: $24-$28/hour
Contract Duration: 6 months, possible extension/conversion
Location: Raton, NM or surrounding area
Work Arrangement: Onsite
Pay Range: $24-$28/hour
Summary
This position is responsible for conducting home health assessments, contacting identified members to inform and educate them on health care programs to address their personal health plan needs, engaging members in discussion of adherence to personal health plans, responding to inquiries from members, and supporting the clinicians in the Medical Management department with their provider and member activities.
Responsibilities
- Responsible for home health assessments and system updates.
- Perform outreach and follow-up attempts to members regarding their health care plan.
- Build relationships with members to encourage compliance with care plans and to alert the Case Manager quickly when issues arise.
- Inform and educate members on their program, utilizing supplied scripts as needed. Complete records in the system by performing data entry. Encourage member utilization of programs, including arranging appointments and additional member services (e.g., transportation). Generate appropriate correspondence and send to members manually, electronically, or telephonically.
- Conduct check-ins with members to review individual care plan goals.
- Maintain production requirements based on established department business needs.
- Provide support to the clinical team by performing the non-clinical functions (as identified by the business process) necessary to generate, manage, and close a case within the platform.
- Receive, analyze, conduct research, and respond to telephone and/or written inquiries. Process information from members or providers to determine needs and ensure customer questions have been addressed. Respond directly to customers or route inquiries to the appropriate internal party.
- Notify the help desk of system issues.
- Perform data entry functions to update customer or provider information.
- Obtain required or missing information via correspondence or telephone.
- May serve as a contact for various groups regarding claims, which involves conducting research, obtaining medical records/letters of medical necessity from TMG, reopening or initiating new cases as needed, and referring cases to clinicians.
- Support and maintain communications with various internal departments regarding group concerns, including Marketing, Provider Affairs, and SSD.
- Communicate and interact effectively and professionally with co-workers, management, customers, and other stakeholders.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable corporate and departmental policies.
- Maintain complete confidentiality of company business.
- Maintain communication with management regarding developments within assigned areas of responsibility and perform special projects as required or requested.
Education & Experience
- Bachelor of Social Work or Psychology OR
- LVN/LPN with 1 year of experience in managed care systems OR
- RN OR
- 3 years of care coordination experience for a state-managed or waiver program OR
- 3 years of managed care systems experience
Knowledge & Skills
- Knowledge of medical terminology
- Experience coordinating member medical-related needs, providing assistance to members, and analyzing member needs
- PC proficiency, including Microsoft Office applications
- Customer service skills
- Verbal and written communication skills, including developing written correspondence to members and other department personnel
- Coaching skills, including motivational interviewing, to educate members on medical issues
Additional Requirements
- Current state driver’s license, transportation, and applicable insurance
- Ability and willingness to travel