Care Anywhere Clinical Coordinator
Job Number: 937
Position Title: Care Coordinator
The Care Coordinator is responsible for UM/CM Coordinator functions as defined below:
(May include but are not limited to)
- Assist team with Daily census by entering Face sheets for hospitals and SNF’s
- Obtain medical records from hospitals and SNF’s
- Attach medical records to authorizations
- Enter referral requests/authorizations in system using ICD 9 and CPT coding
- Monitor Fax Folders
- Contact doctors’ offices requesting additional records
- Creates cases, tasks and completes assessments in Case Management module for all Hospital and SNF discharges.
- Complies with tasks assigned by nurse and, as appropriate, documents accordingly.
- Maintains a case load and contact High Risk members as assigned; follows protocol regarding frequency of contact.
- Maintains documentation on members contacted.
- Assists with COC’s
- Reaches out to members telephonically and meets high risk members in clinic.
- Establishes relationships with members, earns their trust and acts as patient advocate.
- Notifies nurse If members appear to be non-compliant or there appears to be a change in condition
- Assists with outreach activities to members in all levels of Case Management Programs.
- Assists with maintaining and updating member’s records
- Assists with mailing or faxing correspondence to PCP’s, Specialists, related to, as needed.
- Assists with mailing correspondence to members, related to CCIP activities, as needed.
- Requests medical records from PCP’s, Specialists, Hospitals, etc., related to members activities, as needed.
- Performs mini-audits on CM records as directed by Supervisor
- Maintains inventory of educational materials.
- Attends Case Management presentations and participates, as appropriate.
- Recognizes work-related problems and contributes to solutions.
- Meets specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs).
- Maintains confidentiality of information between and among health care professionals.
- Other duties as assigned by CM Supervisor, Manager or Director of Healthcare Services.
Minimum Education and/or Experience:
- High school diploma or general education degree (GED); with one to three months related experience and/or training; or equivalent combination of education and experience. No licensure required.
- Knowledge of ICD9 and CPT codes
- Experience working with IPAs
- Knowledge of Managed Care Plans and medical terminology
- Experience entering referrals and prior authorizations
- Basic Computer Skills, 25 WPM (Microsoft Outlook, excel, word
- Bilingual (English/Spanish) preferred
- Medical Terminology Certificate preferred
- Knowledge working in Access Express/Portal, epic, essett (not mandatory)
- Good oral, written and telephone skills
Skills and Abilities:
- Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Communicates effectively using good customer relations skills.
- Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
- Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
- Computer Skills: Basic skills required.
Other Skills and Abilities:
- Good organizational skills
- Ability to reason and carry out instructions.
- Good interpersonal skills.
- Read, write and speak English fluently.
- File systematically.
Location City: Orange
Location State: California
Community / Marketing Title: Care Anywhere Clinical Coordinator
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact firstname.lastname@example.org.