Care Coordinator II - DME Coordinator

Housecall Providers•Portland, OR

1d•$29 - $35•Hybrid

About The Position

The Care Coordinator II (CCII) plays a crucial role in supporting, managing, and coordinating a patient's care plan. The CCII acts as a liaison between the patient or caregiver, primary care team, and external partners to ensure seamless communication and timely access to care. Primary responsibilities include working in tandem with the primary care team to coordinate healthcare services. The CCII assures continuity of care is maintained and optimized for the patient and their care team’s well-being. NOTE: This position will focus on primary care DME.

Requirements

Minimum 4 years’ experience in a healthcare setting, including experience with medical records system
Advanced knowledge of basic healthcare language, including medical and/or behavioral health terminology, basic patient care and community resources
Demonstrate advanced knowledge of barriers to care such as language, cultural factors, transportation, ability to self-manage and psychosocial issues and bring those to the attention for the care team
Knowledge of HIPAA privacy rules and regulations
Advanced knowledge of basic conflict management and de-escalation techniques
Leadership skills, including the ability to organize work and train/mentor others
Excellent customer service skills, including the ability to interact professionally, patiently and courteously with staff, patients, families and vendors over the phone and in-person
Employ motivational interviewing, healthcare teaching and coaching skills or has the ability to learn
Advanced organizational skills, plus the ability to manage multiple tasks and timelines in a high-stress environment.
Ability to prioritize tasks, manage telephone calls with a professional demeanor, problem solve and stay focused
Work independently and collaboratively
Use good judgment, personal initiative and discretion to perform job responsibilities
Ability to take initiative and utilize innovative techniques and ingenuity
Advanced ability to establish and maintain effective communication and collaborative relationships with colleagues, departments throughout Housecall Providers and CareOregon, as well as external providers and community agencies
Advanced Computer application skills, including MS Windows, Word, Excel and Outlook
Detailed understanding of electronic medical record systems and the ability to integrate updates to those workflows on a regular basis
Advanced ability to facilitate group discussion or case review
Learn, focus, understand and evaluate information and determine appropriate actions
Employ critical thinking and draw conclusions from conversations and written or computer-generated material
Ability to communicate effectively with diverse staff and patients, their families and caregivers
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day

Nice To Haves

Participate in work-related continuing education when offered or directed

Responsibilities

Actively support an assigned panel of patients by providing timely complex care coordination for patients with physical and behavioral health care needs.
Escalate concerns to primary care team according to protocols.
De-escalate high stress situations and complaints received and forwards to primary care team/leadership as appropriate.
Coordinate referrals for supportive services, labs, diagnostics or other coordination of care needs as requested by the primary care team based on insurance, location, patient preference, and order type.
Schedule patient visits for assigned panel of patients based on urgency, geographic location, appointment type, provider availability and frequency of visit standards.
Authorize prescription refills for non-controlled drugs if approved by clinician.
Provide pharmacy support including verbal orders, when appropriate, to expedite or clarify medication fulfillment.
Provide primary care coordination support to assigned panel of patients with physical and behavioral health care coordination needs.
Responsible for meeting with DME vendors to maintain relationships and problem solve.
Manage DME orders, ensuring charting and all documentation requirements are met.
Support providers and patients with DME appeal process and follow up to make sure DME is delivered.
Coordinate complex care with support services and community partners, including but not limited to home health, hospices, according to the patients’ plan of care.
Create/update patient charts and enter insurance, demographic, medication, diagnosis and social information in the EHR, assuring accuracy, completeness and compliance with policies and procedures.
Effectively coordinate care for patients with chronic and serious illness with internal and external stakeholders.
Coordinate with the care team to ensure consideration is given to unique needs in integrated planning and that physical and behavioral health care plans are timely and effective.
Develop working partnerships with patient, family, caregiver and community care providers, payors regarding patient needs and care plans.
Assist with transitions in care from multiple settings to ensure continuity of care and address urgent issues appropriately.
Work with care team to ensure transition in care visits are scheduled according to protocols.
Update hospice and home health regarding patient hospitalizations and transitional care visits.
Act as a consult to other teams and roles (external and internal) for geographically specific resources.
Assist patients, caregivers and families in establishing/engaging with providers by coordinating appointment and transportation, as needed.
Arrange family and/or caregiver attendance at appointments, and interpreters as required.
Provide information about appointments, care plans, medications, referrals, prior authorizations, DME requests.
Identify risk factors and service needs that may impact patient outcomes and address appropriately.
Utilize a trauma-informed approach to provide patient-centric physical and behavioral health care and support including a person-centered approach to communication, education, and care planning.
Assist patients with moving through the continuum of care based on clinical/medical/behavioral health needs by collaborating with the PCP, Primary Care Clinical Team (PCT), palliative care and hospice teams.
Use motivational interviewing to coach patients toward improved physical and behavioral health care behaviors and self-management.
Coordinate clinicians' diagnostic and lab orders, including lab and diagnostic testing, medical supplies and equipment.
Provides timely outreach providing education, follow up on labs or diagnostics or clinical instructions from a member of the primary care team.
Implement physical and behavioral health care coordination plan in collaboration with the patient’s care team, including patient, family, caregiver, internal team members, as well as external providers, case workers and other relevant parties.
Compile and document all patient interactions and support activities in an appropriate and timely fashion to maintain patient's medical record.
Participate in quality and organizational process improvement activities and teams when requested.
Take initiative in proactively assisting teammates when work volumes are high or back up is needed.

Benefits

competitive pay
bonus opportunity
medical insurance
dental insurance
vision insurance
life insurance
AD&D insurance
disability insurance
health savings account
flexible spending account(s)
lifestyle spending account
employee assistance program
wellness program
discounts
multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
strong retirement plan with employer contributions
PTO
Paid State Sick Time
paid holidays
volunteer time
jury duty
bereavement leave