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Outpatient Care Coordinator I
2 months ago
Job DescriptionThe Outpatient Care Coordinator I is responsible for timely processing of Outpatient Clinical Programs cases including, but not limited to, gathering of pertinent medical records, validation of eligibility, completion and/or review of health risk assessments, establishing member-friendly care plans, scheduling of interdisciplinary care team (ICT) meetings, and submission of documents to delegated health plans.ResponsibilitiesJob Responsibilities/DutiesConducts telephonic outreach to members to discuss and offer Outpatient clinical programs.Requests and gathers necessary medical records as needed.Validates patient eligibility, benefits, and medical group affiliation.Administers and/or review Health Risk Assessment and identify member's coordination of care needs. Established basic health care goals with members.Collaborates with the health plan, PCP, and health care team to ensure timely communication of member's clinical information.Works closely with case managers in the development of member-friendly care plans for each member, incorporating the HRA and all other assessment findings.Facilitates warm transfers to member's assigned case manager in accordance with member needs, when appropriate.Schedule and coordinate interdisciplinary care team (ICT) meetings including sending invitations to members, caregivers, PCP, specialists, and other members ICT team per set timeframes.Maintains documentation of member's case, care plan, interventions, and interdisciplinary care team within Prospect's care management system.Compile clinical documentation as required for ICP/ICT bundle submissions per set timeframes.Generate letters, fax to PCP, and mail to members along with resources.Maintains compliance with established departmental productivity guidelines.Maintain internal department trackers and reports.Other projects and duties as assigned.QualificationsMinimum Education: High School Diploma required. Associates Degree or higher preferred.Minimum Experience: Minimum of one (1) year of experience in Case Management Care Coordination in an HMO environment; or any combination of education and experience which would provide an equivalent background required. Prior experience with Managed Care organization. Knowledge of managed care and healthcare.Req. Certification/Licensure: Medical Assistant Certification preferred. Medical Terminology certificate preferred.About UsWith approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
