Job Title: Member Care Coordinator
Location: Bernalillo County, Valencia County, Sandoval County, Santa Fe County, San Miguel County, Mora County, Taos County, Cibola County, McKinley County, San Juan County, and Colfax County.
Remote but you will be expected to visit patient homes
Pay Rate: $25 – $28/hr
Job Summary: The Member Care Coordinator is responsible for conducting home health assessments, contacting identified members to inform and educate them on health care programs, and addressing their personal health plan needs.
Essential Functions:
- Conduct home health assessments and update systems accordingly.
- Perform outreach and follow-up attempts to members regarding their health care plans.
- Build relationships with members to encourage compliance with care plans and alert the Case Manager when issues arise.
- Inform and educate members about their programs using supplied scripts, complete records in the system through data entry, and encourage member usage of our 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.
- Provide support to the clinical team by performing non-clinical functions 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/wants and ensure customer questions are addressed.
- Perform data entry functions to update customer or provider information.
- Obtain required or missing information via correspondence or telephone.
- Serve as a contact for various groups regarding claims, conducting research, obtaining medical records/letters of medical necessity, reopening or initiating new cases as needed, and referring cases to clinicians.
- Support and maintain communications with various in-house areas regarding group concerns, such as Marketing, Provider Affairs, and SSD.
- Communicate and interact effectively and professionally with co-workers, management, customers, etc.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable corporate and departmental policies.
Job Requirements:
- 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 for a state-managed or waiver program OR 3 years of managed care systems experience.
- 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, and coaching skills, including motivational interviewing, to educate members on medical issues.
- Current state driver’s license, transportation, and applicable insurance.
- Ability and willingness to travel.