Case Management Coordinator

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Description

• Accurately enter confidential data into the case management system to ensure timely care coordination and outreach.
• Verify member benefits and eligibility upon receipt of care coordination or case management.
• Utilize DOFR or delegation agreements to drive decision making.
• Coordinate and assist with patient appointments, transportation or utilize community resources.
• Gather relevant information for the identified member population during assessment, care planning, interdisciplinary care team meetings, and transition of care.
• Complete applicable patient assessments in a timely manner.
• Coordinate with case manager to actively problem solve for patients.
• Proactively outreach to patients to verify that needs are being met and services are being satisfactorily delivered.
• Intervene at the client level to coordinate the delivery of direct services to clients and their families.
• Coordinate with primary can specialty providers to provide care to patients.
• Ensure all documentation and communication is complete and updated to partners at the IPA or MSO level and all clinical teams are updated to authorize patient services.
• Review all available community resources prior to requesting patient services for use and authorization.
• Serve as a resource for patients, providers, internal teams and external customers regarding plan policies, benefits, and care coordination.
• Support the Utilization Management department by uploading member admission, home health and skilled nursing facility admissions. Collaborate with department leadership to coordinate calendars for meetings and coordinate interdisciplinary team communications.
• Serve as the Outreach Liaison between the IPA/MSO's for all delegation reports and communications.
• Regular and consistent attendance
• Other duties as assigned

Requirements

• High School diploma or GED required.
• Minimum of 2 years of experience working in the healthcare industry.
• Minimum of 1 year of prior experience working, training, or education within a healthcare environment.
• Strong working knowledge of prior authorization, case management principals, and regulations governing Medi-Cal, Medicare, and other government and commercial healthcare programs.
• Working knowledge or medical terminology.
• Excellent written and verbal communication skills with the ability to build and foster strong interpersonal relationships.
• Bilingual in a second language preferred.