Care Coordinator-1

About the role

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health . Job Summary The Care Management Care Coordinator functions as an integral part of the Care Management department. They are a member of a team that supports the day-today functions of a complex medical network and activities include, but not limited to, outreach functions, assignment of care management cases, mailbox communication and referrals, other. This individual must be able to plan, organize, and prioritize work to ensure completion in a timely manner. He/she functions as a key contact and department representative both to internal and external customers of the care management department through verbal and written communications. Job Description Key Responsibilities/Duties - what you will be doing (top five): Support the General Case Management Process within Case Management Department: Initiates outreach cycle and documents in electronic record and/or member referral status. Accurately identifies when to escalate issues which may prevent meeting department timelines for completion of notification to providers for denials and for requests for information. Track, manage and triage member needs within the defined intervention period for the member specific population, complete follow-up responsibilities within required timeframe. Provide education and coaching to the member, family, and/or caregiver about follow up care and health status, goals of transition care, and health insurance benefits to assist members in making the most informed decisions and to promote self-management of care! Ensure timeliness in coordination of health care services. Assist members with scheduling appointments, tests, screenings, and transportation. Assist execution of special projects and outreach campaigns Communicate with outside stakeholders and vendors appropriately to coordinate member care as needed. Performs general office duties: Accurately enter data into MedHok, Casetrakker and/or Jiva, and other databases and tracking programs Complete clerical and Right Fax tasks as required. Effectively prioritize tasks and ensure deadlines are met. Employ multi-tasking skills when multiple deliverables are due. Employ multi-tasking skills when multiple deliverables are due. Accurately identifies any issues to escalate to a Team Leader Support Clinical Initiatives and Programs: Supports the development and implementation of programs related to quality measures. Participate in outbound calling programs to members with potential quality triggers. Provides departmental process support in duties unique to assigned service operations area. Attends scheduled meetings and assigned training sessions. Other projects and duties as assigned. Qualifications - what you need to perform the job Certification and Licensure Education Required (minimum): High School degree. Preferred: Associate's degree in business and/or related administrative or clinical field is highly desirable.

Requirements

• Required (minimum): 3-5 years' experience in a professional environment.
• Preferred: Experience in a health care environment, especially in managed care is highly desirable
• For internal applicants, experience is required in) Casetrakker, JIVA or the MedHok platform. External applicants must demonstrate potential to become proficient in Casetrakker, JIVA or the MedHok platform within 3 months of training.
• Skill Requirements
• Strong knowledge of Clinical Services' departments and Point32Health organizations in order to assess situations and direct internal and external customers appropriately accurately and quickly.
• Strong computer skills with proficiency required in Microsoft Word, Excel, in an e-mail program and the Intranet. Experience in Power Point, Access, Visio, and other software applications desirable.
• Work independently and cooperatively as a team member across multiple levels within the organization
• Must have a commitment to excellence in customer service.
• Must have well developed written and verbal communication skills.
• Ability to identify emergency situations and fo

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