Care Coordination Specialist II
2 weeks ago
Position Overview:
The Outpatient Care Coordinator II plays a crucial role in identifying and alleviating obstacles to patient care. This position involves assisting members in finding and utilizing resources while educating them on the significance of timely healthcare access.
Key Responsibilities:
- Act as the primary liaison for members, integrating into the interdisciplinary care team to support members in navigating the healthcare landscape.
- Collaborate closely with case management teams to address access, medical, and psychosocial issues effectively.
- Manage and prioritize a designated caseload, ensuring optimal care coordination for Health Plan members.
Essential Duties:
- Conduct telephonic outreach to members regarding outpatient clinical programs.
- Oversee a caseload of members, coordinating care based on their specific needs.
- Engage with members through telephonic and in-person interactions as necessary.
- Review Health Risk Assessments to identify care coordination requirements.
- Establish member-friendly care objectives and facilitate appointment scheduling and authorizations to expedite care requests.
- Ensure completion of quality measures through education and coordination efforts.
- Process incoming referrals to outpatient programs promptly.
- Perform post-discharge follow-up calls to assess additional needs, including scheduling follow-up appointments and coordinating services.
- Collaborate with health plans, primary care providers, and healthcare teams to ensure timely member support.
- Facilitate warm transfers to case managers as needed.
- Identify and facilitate referrals to Long Term Support Services, Behavioral Health, and community resources.
Qualifications:
- Education: High School Diploma required; Associate's Degree or higher preferred.
- Experience: Minimum of one year in Case Management Care Coordination within an HMO environment or equivalent experience. Prior experience in Managed Care is preferred. Bilingual proficiency is advantageous.
Skills:
- Strong prioritization and multitasking abilities.
- Excellent communication skills.
- Experience working with seniors or individuals with disabilities in a customer service context is preferred.
Certifications:
- Medical Assistant Certification and Medical Terminology certificate preferred.
About Prospect Medical Holdings:
With a network of approximately 9,000 physicians serving 260,000 members, Prospect Medical Systems is recognized as a leader in innovative healthcare solutions across California, Texas, and Rhode Island. Our comprehensive services range from primary and specialty care to acute hospital and skilled nursing facilities, as well as behavioral health and wellness services.
For over 25 years, we have been dedicated to supporting independent physicians through collaborative risk arrangements, ensuring high-quality, coordinated, and personalized care for our patients.
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