Healthcare Case Coordinator

2 weeks ago


California, Missouri, United States Spectraforce Technologies Full time

Position:
Healthcare Case Coordinator (RN)

Duration: 03 Months with potential for extension

Work Arrangement:

Fully remote - candidates can be located anywhere in the US, but must possess a valid CA RN license and be available to work during PST hours.

8 AM - 5 PM PST, Monday to Friday

Key Responsibilities:

- Engage with Medicare/Medicaid systems

- Assist in managing referral backlogs from California members to case managers

- Handle 5-10 referrals daily

- Thrive in a fast-paced work environment

- Previous case management experience is essential

- Dedicate at least 4 hours daily to outbound calls to members

- Participate in audio audits of recorded calls

- Conduct data entry and maintain accurate tracking

- Manage a caseload of 75, with a gradual ramp-up

- Basic proficiency in Excel for data entry

- Navigate True Care medical records system and various other platforms

- Utilize pharmacy systems, eligibility systems, and workforce management tools

Essential Duties:
  • Develop, evaluate, and modify care plans to achieve desired outcomes
  • Assess members' health status, resource utilization, and treatment options
  • Coordinate services among Primary Care Physicians (PCP), specialists, and medical staff to address comprehensive client needs
  • Create care plans based on assessments with clear objectives and interventions
  • Provide education to patients and healthcare providers
  • Facilitate access to community services for members
  • Monitor referrals to community organizations and medical services to support overall care management
  • Actively engage in integrated team care management discussions
  • Identify and report quality concerns related to risk management
  • Maintain accurate records of assessments, authorizations, and clinical information in medical management systems

Qualifications:
- Graduate from an accredited nursing program; a Bachelor's degree in Nursing is preferred

- Minimum of 2 years of clinical nursing experience in acute care or community settings

- Familiarity with healthcare and managed care systems is advantageous

Licenses/Certifications:
- Current RN license in California

Performance Metrics:
- Calls are recorded, and case management is closely monitored

Collaboration:
- Work with various internal and external groups

Required Skills:
  • Experience with Medicare/Medicaid systems
  • Background in Psych/Behavioral Health
  • Proven case management experience
  • Bilingual in Spanish is a plus

Software Proficiency:
- MS Office, Excel

Compliance:

The Company adheres to the California Privacy Rights Act (CPRA) and all relevant data privacy laws.



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