Coord, Central Intake Case Mgt

Job Summary:

Responsible for the initial review and triage in the referral process for members referred to the Case Management Program. The goal is to support timely review/response and facilitate a smooth transition from the beginning of the referral process to the appropriate case manager, social worker, and/or other responsible KP program (s) or entity. These central intake activities in conjunction with KPGA case management staff, will serve to ensure appropriate, seamless and a comprehensive approach in referrals for KP Members by Providers and by staff.

Essential Responsibilities:

• Responsible for all case management central intake coordination activities. Receives and monitors case management referrals through the utilization of the telephone, any business-related electronic methods such as Health Connect, KP.org, Lotus notes, and face to face.
• Performs timely (preferably same day) reviews on all referrals to the Case Management Program within the designated timeframe per policy and procedure and evaluates priority (routine/urgent) for case management based on established guidelines.
• Based on initial analysis, determines the members need (s), and responds to the referral source on the next level of the referral process preferably same day, but no longer than 2 business days.
• Refers the member to Complex Case Management: includes but not limited to Social Services, Disease Specific Case Management or other KP Programs if appropriate.
• Continuously coordinates, monitors, tracks, and evaluates all care and services rendered to ensure that quality care is being delivered and in the most appropriate setting.
• Makes referrals to other KP programs for continued care. These programs may include but are not limited to Healthy Solutions, Living Well Classes, Chronic Kidney Disease/ESRD program, Elder Care/CCIP program, Heart Failure program, etc.
• Performs and documents all central intake interactions and interventions in the case management documentation system and Health Connect (HC) according to Guidelines.
• Central Intake Coordinator will obtain the necessary basic information to accurately screen the referral and determine the next step. Coordinator will document receipt of the referral in the case management documentation system, verify eligibility, benefit coverage and will indicate the next steps taken.
• Referrals which may be completed without any additional interventions, will be documented as no other assistance required, in the case management documentation system.
• Central Intake Coordinator will be responsible for informing the referral source of the next steps taken, via various communication methods as outlined in the Central Intake Policy and Procedure.
• Arranges, coordinates, and facilitates appointments for the member when necessary.
• Refers cases identified as risk management, peer review or quality issues to Risk Management.
• Performs quality of care and service reviews using identified quality indicators.
• Acts as a resource to TSPMG practitioners, contracted consultants, Health Plan administrators and medical office staff.
• Works cross-functionally with other departments in striving to meet organizational goals and objectives.
• Reviews the statistics of central intake interventions with the Supervisor and makes adjustments based on findings.
• Acts as a team coach for respective areas of responsibility regarding enhanced customer service, quality of work performed and productivity of staff.
• Investigates, identifies, and reports problems and inefficiencies in existing systems, and recommends changes when appropriate to the Case Management Team Leader.
• Responsible for assisting the Medical Office Administration, Customer Services and Provider Relations in investigating concerns and issues.
• Knowledgeable and compliant with regional personnel policies and procedures.
• Knowledgeable and compliant with Quality and Patient Safety departmental and unit specific policies and procedures.
• Participates in annual regional and departmental compliance training.
• Knowledgeable and compliant with Principles of Responsibility.
• Develops and maintains an awareness of how to report compliance issues and concerns. Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.
• Your access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform your job.
• May perform other duties as assigned.