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Coordinator - Care Management
3 months ago
**What you can expect**
Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an **authentic experience**
Under the general supervision of the Care Management (CM) Manager and direct supervision of the CM Coordinator Supervisor, the CM Coordinator is responsible for advocating, facilitating and supporting care management activities.
**Key Responsibilities**
- Responsible for assisting Members with care coordination in respect to referral process such IPA for Durable Medical Equipment (DME), home health, and Specialist needs.
- Responsible for assisting the Care Managers in the management and coordination of care of Member identified with care management conditions.
- Responsible for facilitating Member care to ensure that a continuity of care letter of agreement (LOA) is executed when appropriate.
- Collaborates on Member’s care issues with other team members and consults with NCM or CM supervisor to ensure that appropriate treatment plan is followed, thoroughly and promptly.
- Responsible for processing and coordinating divorces, disenrollment, transportations, and language interpretation as needed and applicable.
- Assists with contact calls for monthly HRA pull, i.e., Complex Case Management and assisting with coordinating the members overall care as needed.
- Responsible for identifying HEDIS gaps and contacting the member to address these gaps.
- Responsible for covering Cisco ACD Queue telephone lines and Phone queue.
- Assists with the coordination of access issues with PCP offices, specialists, radiology services and ancillary services such as PT, OT, speech therapies.
- Ensures documentations is accurate and in compliance with regulatory requirements and accreditation standards.
- Consults with assigned nurses for clinical assessment and decision prior to taking action that are clinical in nature.
- Performs any other duties as assigned or required to ensure Health Plan operations are successful.
- Participates in Medical Services staff meetings or other activities as needed
- Ensures the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance including attending annual compliance training.
- Promotes a positive and collaborative working environment within the CM Team.
- Any other duties as required to ensure Health Plan operations are successful.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
**Perks**
IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
- CalPERS retirement
- 457(b) option with a contribution match
- Generous paid time off
- vacation, holidays, sick
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Paid life insurance for employees with additional options
- Short-term, and long-term disability options
- Pet care insurance
- Flexible Spending Account - Health Care/Childcare
- Wellness programs that promote a healthy work-life balance
- Career advancement opportunities and professional development
- Competitive salary with annual merit increase
- Team bonus opportunities
**Education & Experience**
- Two (2) years customer service experience in medical clinics, hospitals, or IPAs
- Associate's degree or Bachelor’s degree from an accredited institution preferred
**Key Qualifications**
- Excellent written and verbal communication and interpersonal skills
- Experience in data entry
