Outpatient Care Coordinator II
5 days ago
We are seeking a highly skilled Outpatient Care Coordinator II to join our team in Orange County. As a key member of our interdisciplinary care team, you will play a vital role in identifying and reducing barriers to members' care, assisting them in locating and accessing resources, and educating them on the importance of accessing care promptly.
Key Responsibilities- Conduct telephonic outreach to members to discuss and offer outpatient clinical programs.
- Oversee a caseload of basic members to manage and coordinate care according to members' identified needs.
- Interact with assigned members telephonically and/or in-person as appropriate.
- Review Health Risk Assessments and identify members' coordination of care needs.
- Establish member-friendly care goals with members.
- Coordinate care for members as appropriate, including scheduling appointments and creating authorizations to facilitate/expedite members' requests.
- Facilitate completion of quality measures through education and coordination.
- Timely process incoming referrals to outpatient programs per set timeframes.
- Complete post-discharge calls for members per set timeframe, determining additional post-discharge needs such as scheduling follow-up appointments and coordinating ordered DME and services.
- Collaborate with the health plan, PCP, and healthcare team to ensure timely coordination of members' needs.
- Facilitate warm transfers to members' assigned case managers in accordance with members' needs, when appropriate.
- Identify the need for and facilitate referrals to Long Term Support Services (LTSS), Behavioral Health, and other community resources.
- Guide members in understanding and accessing the health plan benefits they are entitled to.
- Maintain timely documentation of members' cases, care plans, interventions, and interdisciplinary care teams within our care management system.
- Mail out educational and community resources information to members.
- Assist case managers in obtaining medical records for members.
- Generate letters, faxing to PCP, and mailing to members along with resources.
- Maintain compliance with established departmental productivity guidelines.
- Maintain internal department trackers and reports.
- Other projects and duties as assigned.
We require a minimum of one (1) year of experience in Case Management Care Coordination in an HMO environment, or any combination of education and experience that would provide an equivalent background. Prior experience with Managed Care organizations is preferred, as is knowledge of managed care and healthcare. Bilingual language proficiency is also preferred. Ability to prioritize and multi-task, excellent communication skills, and a professional attitude when working with internal and external customers are essential.
A Medical Assistant Certification and Medical Terminology certificate are preferred, but not required.
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