Care Management Coordinator
2 weeks ago
The Care Management Coordinator supports the daily operations of care coordination within the VBC framework. This role facilitates communication between care teams, providers, patients, and community resources to ensure seamless transitions of care, efficient use of resources, and improved patient outcomes. The coordinator works collaboratively with case management, social worker, providers, and other departments to monitor, coordinate, and support patient care and population health initiatives. In addition, you will be responsible for contributing to the growth and success of HealthTexas while upholding our Mission, Vision and Values.
Culture and Values Expectations
At HealthTexas, we believe that our workplace culture is the cornerstone of our success. We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential. Our culture is the driving force behind our mission "to deliver quality and compassionate care with outstanding service, every patient, every time". As a Medical Management at HealthTexas we expect you to embody and promote our Values and defined behavioral expectations.
- Integrity: Do the right thing, the right way, every time.
- Be honest and uphold commitments and responsibilities, earn the trust and respect of the team and those we serve, and maintain privacy and confidentiality.
- Compassion: Treat everyone with respect and dignity.
- Foster an environment of inclusivity and well-being, practice patience and empathy, and assume positive intent.
- Synergy: Collaborate to improve outcomes.
- Invite and explore new opportunities, promote effective communication and teamwork, take pride in yourself, your work and HealthTexas.
- Stewardship: Use resources responsibly and efficiently.
- Implement effective strategies to attain goals, achieve maximum productivity and results, and seek continuous knowledge and improvement.
- Establish and maintain professional rapport with providers, members and other team members.
- Maintain productivity reports and other reports needed by leadership on a regular basis.
- Reviews and tracks all incoming faxes, emails, and/or reports for VBC population census for ER visit, Observation stay, Inpatient admission and Discharge notifications.
- Establishes and maintains the daily census for ER, Observation stay, inpatient for VBC populations such as Medicare Advantage, Aetna Whole Health and Medicare ACO.
- Obtain medical records when applicable and input into electronic documentation system.
- Will assist as needed on member outreach calls such as Post ER or Post Discharge to assist with screening and scheduling office visit with Primary Care Provider within TCM guidelines.
- Educate member on navigation of health plan provider network, appropriate levels of care to utilize (PCP, Urgent care, or ER), and other benefit plan programs available to manage their health conditions.
- Assists with Value Based Quality measures such as HRA uploading
- Will assist with coordination of members enrolled in Medicare ACO and UHC SNP/Non SNP program such as PCP notifications of alerts and communications from ACO team.
- Assist with care coordination such as Home Health, medication prescriptions, durable medical equipment needs for the member.
- Will promote quality measures and assist as needed in calling members when scheduling a visit, lab, test, or procedure to meet and comply with completion. (Ex. HEDIS measures, mammogram, colorectal cancer screening)
- Comply with all guidelines established by the Centers for Medicare and Medicaid (CMS), if applicable.
- Participate in VBC annual events (Ex. Flu Clinics, Health Fairs)
- Other duties assigned by the director and/or supervisor.
- Minimum of 1 year healthcare experience in physician office, managed care insurance, or other healthcare setting.
- Computer experience in MS Office products and medical EMR programs.
- High School diploma or equivalent
- CMA preferred
- Knowledge of Medical Management concepts preferred.
- Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas.
- Excellent telephonic customer service skills a must.
- A self-starter who is successful with minimal supervision.
- Monday - Friday, 8:00 a.m. - 5:00 p.m., and as needed to complete projects.
- Travel to Flu Clinics, Health Fair sites
- This job operates in an office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets and fax machines.
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Please note this job description is not designed to cover or contain a comprehensive list of activities, duties, or responsibilities that are required of the employee for this job. Job responsibilities, location, work hours, etc., may change at any time with or without notice.
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