Care Coordination Specialist II
2 weeks ago
Position Overview:
The Outpatient Care Coordinator II plays a crucial role in identifying and mitigating obstacles to patient care. This position assists 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 as they navigate the healthcare landscape.
- Collaborate closely with case management teams to address medical, access, and psychosocial challenges faced by members.
- Efficiently manage and prioritize a designated caseload, working alongside licensed clinical professionals to ensure optimal care coordination for Health Plan members.
Essential Duties:
- Conduct telephonic outreach to engage members regarding outpatient clinical programs.
- Oversee a caseload of members, coordinating care based on their specific needs.
- Interact with members through phone and in-person communications as necessary.
- Review Health Risk Assessments to identify care coordination requirements.
- Establish member-centric care goals in collaboration with members.
- Coordinate necessary care services, including appointment scheduling and authorization creation to expedite member requests.
- Facilitate the completion of quality measures through education and coordination efforts.
- Process incoming referrals to outpatient programs in a timely manner.
- Conduct post-discharge follow-up calls to assess additional needs, such as scheduling follow-up appointments and coordinating durable medical equipment (DME) services.
- Collaborate with health plans, primary care providers, and healthcare teams to ensure timely responses to member needs.
- Facilitate warm transfers to case managers when appropriate.
- Identify and facilitate referrals to Long Term Support Services (LTSS), Behavioral Health, and community resources as needed.
- Guide members in understanding and accessing their health plan benefits.
- Maintain accurate documentation of member cases, care plans, and interventions within the care management system.
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 education and experience. Experience with Managed Care organizations is preferred. Bilingual proficiency is advantageous. Strong communication skills and the ability to prioritize tasks are essential.
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 one of the most innovative healthcare systems across California, Texas, and Rhode Island. Our extensive range of services includes primary care, specialty physician services, acute care hospitals, skilled nursing facilities, and behavioral health services. For over 25 years, we have been dedicated to supporting independent physicians and ensuring high-quality, coordinated, and personalized care for our patients.
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