The Clinical Care Coordinator is responsible for welcoming and onboarding new members to the health plan, completing and scheduling assessments and works collaboratively with the health care team to manage and coordinate care for members. This role is also responsible for locating and reengaging those who are difficult/unable to reach through office and community-based efforts. Community-based efforts include, but are not limited to: member home visits, provider office visits, hospitals and other areas. The Clinical Care Coordinator must work collaboratively with members, caregivers, member relatives and health care providers to ensure quality and cost-effective patient-centered care. The Clinical Care Coordinator should feel comfortable when working to overcome environmental, cultural and language barriers. This position works directly with members, staff, managers, and both internal/external customers.
Duties and Responsibilities
Responsibilities include, but are not limited to, the following:
Under the direction of the Manager within Clinical Operations, the Clinical Care Coordinator performs ongoing care coordination activities including:
Conducts outreach telephonically, virtually, and/or face to face
Completes Health Risk Assessment (HRA), initial health screening and member welcome calls
Provides telephonic initial screen of non-medical needs, coordinates services with clinical team and makes appropriate referrals
Provides information to members/clients and/or their care teams regarding social and community supports
Provides assistance with calls to various social service agencies, as appropriate
Performs off-site visits (such as, but not limited to: home, hospital, community health centers or other community agencies) as necessary or required
Provides assistance and collaborates with clinical teams in obtaining access to care, DME and services
Directs members/clients to internal departments within Neighborhood as appropriate
Provides comprehensive documentation of all activities and contacts in appropriate software system
Manage a caseload of assigned members
Collaborates with clinical team and schedules visits for licensed staff
Provides cross-coverage as assigned by Manager
Participates in Outreach/Marketing activities as needed and appropriate
Maintains up-to-date knowledge of resources in Rhode Island
Performs other duties as assigned in alignment with care coordination responsibilities
Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents
Qualifications
Required:
Preferred:
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
Neighborhood's employees come from a diverse background but all are committed to creating a more equitable health care system. Our array of experiences allows us to have a broad perspective and great creativity in facing whatever challenges arise. Unlike many other health insurance companies, we have nearly 30 nurses and social workers on staff. This structure speaks to our focus on active and compassionate care management for our members; we know that people who are alienated from the health care system require additional advocacy, outreach and support.
Neighborhood offers an exceptional compensation package to employees. We annually review base salaries/benefits and adjust as appropriate.