Outpatient Care Coordinator II
2 weeks ago
The Outpatient Care Coordinator II will play a crucial role in identifying and reducing barriers to members' care, ensuring timely access to resources and education on the importance of prompt care. As the primary point of contact, this individual will be an integral part of the members' interdisciplinary care team, providing support and working closely with case management teams to resolve access, medical, and psychosocial issues.
Key Responsibilities- Conduct telephonic outreach to members to discuss and offer outpatient clinical programs.
- Manage and coordinate care for a caseload of members, identifying their needs and establishing care goals.
- Interact with members telephonically and/or in-person, as appropriate.
- Review Health Risk Assessments and identify members' coordination of care needs.
- Coordinate care for members, including scheduling appointments, creating authorizations, and facilitating referrals to outpatient programs.
- Facilitate completion of quality measures through education and coordination.
- Process incoming referrals to outpatient programs in a timely manner.
- Complete post-discharge calls for members, determining additional needs and coordinating follow-up appointments and services.
- Collaborate with the health plan, primary care providers, and healthcare teams to ensure timely coordination of members' needs.
- Facilitate warm transfers to members' assigned case managers, as needed.
- Identify the need for and facilitate referrals to Long Term Support Services, Behavioral Health, and other community resources.
- Guide members in understanding and accessing their health plan benefits.
- Maintain timely documentation of members' cases, care plans, interventions, and interdisciplinary care teams within the care management system.
- Mail educational and community resources information to members.
- Assist case managers in obtaining medical records for members.
- Generate letters and fax them to primary care providers and mail them to members, along with resources.
- Maintain compliance with established departmental productivity guidelines.
- Maintain internal department trackers and reports.
- High School Diploma required; Associates Degree or higher preferred.
- 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 organizations preferred.
- Knowledge of managed care and healthcare preferred.
- Bilingual language proficiency preferred.
- Ability to prioritize and multi-task.
- Excellent communication skills.
- Working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity, HMO, Medi-Cal, and/or health services experience preferred.
- Maintain a professional attitude when working with internal and external customers.
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