CARE MANAGEMENT COORDINATOR

Description

Summary: The Care Management Coordinator (CMC) supports an assigned Medical Care Management Nurse.

Essential Duties and Responsibilities include but are not necessarily limited to the following. Other duties may be assigned.

• Work directly with assigned Medical Care Management Nurse.
• Contacts members by phone, mail, or email as directed by Medical Care Management Nurse.
• Responsible for generating reports and documents that pertain to member case management.
• Act as liaison between the reinsurance department and assigned Nurse Care Management team regarding various reports in the claims/UR system.
• Act as point of contact between Client Management and Nurse Care Manager.
• Contact providers to obtain clinical documentation for members.
• Maintain strict HIPAA Confidentiality; follow all internal policies and procedures to maintain the confidentiality for all members and member data.
• Follow written criteria, policies and procedures in reviewing and processing daily referrals for outpatient and inpatient medical care as needed to back up UR Coordinator.
• Remain in constant daily contact with other Care Management Department.
• Work independently on assigned tasks and activities, based on established policies and procedures.
• Perform other duties and responsibilities as assigned by the Management.

Supervisory Responsibilities: This job has no supervisory responsibilities.

Requirements

Knowledge, Skills, & Abilities:

• Strong communication skills, effective and accurate written and verbal form.
• Ability to evaluate and comprehend clinical documentation.
• Strong customer service oriented skills for both internal staff and external clients.
• Strong organizational skills which support timely and well documented action to manage concurrent deadlines and multiple priorities.
• Keyboarding skills and the ability to utilize computer equipment and software are required as is experience with other types of standard office equipment.
• Strong working knowledge of Microsoft Office, excel, windows based products and software specific to document scanning.
• Medical terminology required.
• Working knowledge of ICD-10, HCPCS and CPT coding.
• Ability to work independently and within a team environment.
• Knowledge and ability to utilize evidence based medical guidelines.
• Durable Medical Equipment knowledge preferred.
• Must be able to, with reasonable accommodation, sit for extended periods of time; view and input data on PC for extended periods of time; stand, stoop, lift, carry and walk on an intermittent basis.
• Must be able to work within core hours of operation 8 am to 5 pm

Qualifications: 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:                   

High School diploma or G.E.D, college degree preferred; and minimum of two to four years medical or insurance experience; or equivalent and any combination of education, training, and/or experience, which demonstrates ability to perform the duties described.

Language Skills: 

• Bilingual Spanish/English preferred.                  
• Ability to read, speaks, and writes effectively in English. Ability to interpret documents such as safety rules, memos, letters, and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position.

Mathematical Skills:                   

Ability to add and subtract, multiply and divide with 10's and 100's.  

Reasoning Ability:                   

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations.

Certificates, Licenses, Registrations: 

N/A

Physical Demands: 

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.  This position requires the employee to work in the office.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.