Member Care Coordinator

Job Description

Job Description

Position Summary

The Member Care Coordinator position is a non-clinician role that works in collaboration with the Care Management staff and / or quality improvement staff to support the multi-disciplinary team approach of patient care by meeting key performance indicators (closing care gaps, reducing hospitalizations, readmissions, ED utilization, and PMPM costs) and other organizational mandates as designated.

The Member Care Coordinator may work remotely within regions to cover the needs across the state and / or may work on site at CCPN practices.

Member Care Coordinators may directly assist members in improving their ability to improve their health outcomes. They also help design and implement systems to ensure the smooth operation of office functions and to support the Care Team.

Member Care Coordinators may also work directly with assigned practices to assist them in addressing care gap closure under the direction of Provider Relations Representatives.

Essential Functions

• Receive and document all referrals from various sources into the Care Management documentation platform
• Verify eligibility and demographic information
• May complete Health Risk Screenings as needed
• Assist with mailing of educational materials, consent forms or other documents to the member as necessary
• Assist with referrals on behalf of the Care Management team
• Provide information for access and coordination of resources
• Assist member with care coordination and health care system navigation
• Provide culturally appropriate health education and information
• Provide general education and social support
• Advocate for members
• Identify care gaps and perform outreach to members in attempt to close gaps as requested
• Assist practice to submit supplemental data to health plans to provide documentation of gap closure as requested; assist with scheduling medical appointments and transportation as needed
• Assist to address with Social Determinants of Health as needed
• Access multiple EHR’s to obtain and upload into the care management platform
• Access to Hospital / Data or Electronic Medical Record system will be required, as necessary
• Notify supervisor promptly of any issues with carrying out any duties assigned
• Adhere to CCNC Privacy and Security policies to ensure that patient and company data is properly safeguarded
• Abide by department guidelines, company policies, and HIPAA regulations
• Perform other duties that assist in keeping the operations organized and functional
• Attend Departmental and corporate meetings, local and regional training, or other events as required
• Understand and uphold CCNC goals, objectives, and standards
• Travel using a personal vehicle will be required within the region and / or the State

Qualifications

• High school diploma or GED required; or Licensed Practical Nurse
• 2-4 years minimum experience in a health care setting required
• 2- or 4-year degree in health-related field preferred
• Bilingual preferred
• Maintain a valid driver’s license with current auto liability insurance

Knowledge, Skills, and Abilities

• Knowledge of and experience working in patient or clinical data systems
• Computer skills required including various office software and the internet; experience with MS Office software preferred
• Knowledge of state and federal benefits system
• Excellent communication skills oral and written
• Proficient Motivational Interviewing skills
• Organizational and time management skills
• Sensitivity to diversity of cultures, language barriers, health literacy and educational levels
• Knowledge of medical terminology
• Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives
• Able to shift strategy or approach in response to the demands of a situation

Working Conditions

• The job environment is primarily an office or home environment.
• Multiple contacts are required with various members, providers, multi-payer systems and community partners to ensure coordination of services;

exposure to general office and household conditions, as well as communicable disease could occur

• Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time
• Must be able to utilize office equipment, computer, keyboard and phone with or without assistive devices
• Repetitive wrist motion and occasional lifting / carrying of up to 25 pounds
• Travel will be required within the region and / or the State
30+ days ago