Lead Care Manager
4 weeks ago
We are seeking a highly motivated and experienced Lead Care Manager to join our Enhanced Care Management Team in Los Angeles, CA. The successful candidate will be responsible for providing case management services to qualified members, participating in the planning, development, implementation, and evaluation of services, and coordinating a full range of physical health, behavioral health, and community-based services.
Key Responsibilities:
- Conduct initial assessments and periodic reassessments of client's needs
- Lead the provision and coordination of services and provides direct services for HHP participants in their assigned caseload
- Develop patient-focused care plans in partnership with other providers and the client
- Work with medical staff to develop, implement, and coordinate care plans for clients with chronic conditions such as diabetes, asthma, behavioral health conditions
- Responsible for driving a positive patient customer service experience through multiple support channels
- Respond to inquiries from patients and outside agencies and refer, when necessary, to the appropriate person or department
- Adhere to all organizational policies, HIPAA regulations, and Joint Commission guidelines
- Schedule weekly and monthly phone calls with members
- Monitor and report changes in patient symptoms or behavior
- Monitor and maintain goal levels of calls per hour calls placed on hold, ring no answer, transfer out, and availability in Queue
- Capture patient demographics information, insurance information, and structured data into patient management systems during each phone encounter
- Communicate to PCP any significant changes in patient concerns along with any updates on patient status
- Educate patients about health maintenance and disease prevention
- Complete all required documentation accurately, in a timely manner, and thoroughly in accordance with department standards
Requirements:
- Minimum of one year of experience in a healthcare related field or customer service
- Execute and maintain confidential information according to HIPAA standards
- Possess a high level of tolerance and understanding for individuals with urgent and multiple case management and health needs
- Demonstrate strong skills in technology including electronic health record systems and Microsoft Software
- Exercise mature judgment, and are highly motivated, self-starting, and proactive
- Excellent at communicating, whether in writing or verbally
- Have a strong sense of prioritization and can coordinate multiple demands in a high-pressure environment
- Ability to build rapport with patients
- Ability to communicate with patients from diverse backgrounds
- Strong problem solving and critical thinking skills
- Ability to work independently
- Bi-lingual in English and Spanish is a plus
- Working Knowledge of EMR systems
- Strong communication skills, verbal and written
- Experience and demonstration of strong customer service skills
- Excellent oral and written communication skills
- Basic working knowledge of insurance coverage, the insurance eligibility process
- Sensitivity to the needs and situations of multi-cultural populations from a variety of income levels
- Be able and willing to work flexible hours as needed including evenings, weekends, and holidays
- Excellent attention to detail
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Environment:
Moderate noise level; fast-paced high energy.
Travel:
Staff will travel within the Los Angeles region as needed. Mileage reimbursement for the use of your vehicle is at a standard rate.
Confidentiality:
Maintains patient, employee, and Foundation confidentiality at all times, discussing patient or employee business only with appropriate parties who have a bona fide need to know; and communicating only the minimum amount of information necessary with respect to protected health information (PHI) as defined by the Health Insurance Portability and Accounting Act of 1996 (HIPAA).
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