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Care Coordinator

1 month ago

Shrewsbury, Massachusetts, United States UMass Med School Full time
Care Coordinator Job Description

Job Summary: We are seeking a highly skilled Care Coordinator to join our team at UMass Med School. The successful candidate will be responsible for coordinating medical access services, communicating with clinical and administrative staff, and managing critical data.



Key Responsibilities:

  • Coordinate the scheduling of medical services for the Federal Bureau of Prisons (FBOP).
  • Maintain a process for scheduling network hospital appointments consistent with contractual requirements and FBOP security protocols.
  • Utilize independent judgment to identify and resolve barriers to service.
  • Work remotely from the Federal Medical Center at Devens, coordinating and running all aspects of assigned onsite specialty clinics.
  • Act as the primary point of contact for the Justice Health & Equity (JHE) contracted specialty provider for the assigned clinics.
  • Prepare medical records for onsite specialty clinics, including related imaging, test results, and patient history.
  • Utilize the Bureau of Prisons Electronic Medical Record (BEMR) to review consultation requests and create inmate patient schedules.
  • Audit encounter forms and provider BEMR documentation for accuracy and review any potential issues with the provider prior to clinic end.
  • Provide continuous education to providers to ensure patient encounters are completed thoroughly and accurately for claims submission.
  • Audit daily time sheets of contracted providers documenting hours worked.
  • Maintain proper boundaries when interacting with patients and seek direction or clarification from supervisor and/or BOP staff when necessary.
  • Review daily written consultation requests/medical referrals from the FBOP primary care team, clarifying requests with prison staff, and adding referrals to the claims processing software.
  • Identify problematic or incomplete consultation requests/medical referrals, determine gaps in service delivery, and research potential out-of-network alternatives.
  • Serve as the primary liaison between FBOP providers and staff and community-based physicians and their staff to schedule services, communicate information, and identify and resolve issues regarding medical appointments and procedures.
  • Collaborate with the FBOP healthcare team to communicate the status of referrals and changes to ensure continuity of care.
  • Provide the linkage between FBOP referring providers and community providers to promote the timeliness and efficiency of services.
  • Develop and maintain a system to request and retrieve medical record information for all scheduled appointments and procedures, ER trips, and inpatient stays for FBOP patients across all network hospitals.
  • Review all medical referrals to ensure an appropriate provider is chosen based on specialty, geographical location, provider availability, and client preference while being fiscally responsible and leveraging primary network hospitals when appropriate.
  • Maintain the schedule for medical services provided at the prison, anticipating variances in time to allow for correction.
  • Collect time sheets documenting hours worked on a weekly basis.
  • Maintain referrals/prior authorizations, patient appointments, ER trips, and inpatient stays in the JHE claims management software.
  • Produce data and reports on utilization, types of services, and access to services.
  • Independently develop and continuously deliver education regarding FBOP safety and security protocols regarding inmates as patients to the community hospital network providers and their staff.
  • Makes complex decisions regarding privacy matters associated with the client's case, including determination of who JHE may exchange information with, what information may be shared, and what is required by HIPAA to allow conversations to take place.
  • Corresponds and communicates daily with community providers and FBOP, handling sensitive and confidential records/information for clients.
  • Ensures accurate appointment and scheduling information is entered into the JHE claims management system in a timely manner.
  • Produces daily and weekly audits of prior authorizations and scheduling data for accuracy.
  • Provides critical, highly sensitive scheduling and utilization reports to the FBOP client for continuity of care planning and security staffing per contract requirements.
  • Addresses clients, providers, and agencies in an expert manner with excellent written and verbal communication and organizational skills.
  • Resolves all issues and ensures that electronic data transmission is performed in a secure manner, according to FBOP and ForHealth Consulting data security policies and procedures.
  • Complies with established policies, health and safety regulations, and requirements, procedures, and department objectives.
  • Performs scanning functions, faxing, scanning of daily provider schedules, letter to providers, dictations to sign, and other documents on a daily basis.
  • Monitors and evaluates all care coordination procedures and identifies areas for improvement.
  • Initiates and implements new procedures in collaboration with the Care Coordination team, Claims team, and FBOP Health Information Management team as needed.


Requirements:

  • High School Diploma.
  • 3 to 5 years of relevant complex office or direct healthcare experience.
  • Demonstrated knowledge of medical terminology.
  • Knowledge of HIPAA laws and regulations, especially as it refers to the confidentiality of PHI.
  • Knowledge of Microsoft Office products, Word, Excel, PowerPoint, and Outlook.
  • Ability to handle stressful and difficult situations in a calm and professional manner.
  • Must possess demonstrated verbal and written communication skills necessary to work effectively with a diverse population, both on the telephone and in person.
  • Attention to detail, ability to prioritize, and function independently.
  • Position is contingent upon passing a background check from the Federal Bureau of Prisons and a willingness to work within a Medical Center operated by the Federal Bureau of Prisons.


Preferred Education and Experience:

  • Associates degree or some college in business or related field, including healthcare.
  • Experience in a high-functioning, multi-faceted, medical setting.
  • Ability to independently organize and prioritize work responsibilities and the demonstrated ability to apply critical thinking skills to solve problems.
  • Familiarity with medical terminology and CPT codes strongly preferred.
  • Excellent communication and interpersonal skills.
  • Knowledge of ForHealth data security procedures, standards, and requirements regarding the confidentiality of protected health information.