Care Coordinator

ChenMed•West End, MT

6d•Onsite

About The Position

The Care Coordinator will work with Care Center of Excellence, Physician Management Resources (PMR), external clients, and HMOs to establish, maintain, and support outpatient utilization management in PMR and delegated utilization management in ChenMed Medical Centers. This role involves daily review of approved and pended outpatient requests, providing insights to the PMR team and Network Director, and facilitating processes to manage requests, especially when patients need to see a primary care provider. The position also focuses on driving the utilization management model towards sustainability and reproducibility based on market needs, with potential travel to PMR & ChenMed markets for training and support.

Requirements

Excellent analytical skills in order to solve the complex and logistical problems.
Strong communication and interpersonal skills, both written and verbal, as well as delivery skills for presentations and training.
Excellent organizational skills with ability to effectively manage multiple tasks and responsibilities.
Ability to deliver efficient, high quality results within tight deadlines.
Works well independently and within a team.
Excellent influencing and negotiation skills.
Ability to explain complicated financial terms and utilization data to physicians/staff.
Ability to understand, interpret and communicate all types of provider, regulatory contracts and utilization management data.
Fluent in English.

Nice To Haves

An understanding of the communities that ChenMed and PMR serves, including the complexities of Medicare programs to patients in the current healthcare marketplace.

Responsibilities

Daily review of approved and pended outpatient requests for PMR clients and ChenMed Markets.
Provide insights to the PMR team and Network Director and work with them to take action.
Facilitate a daily process to help redirect poorly supported requests by providing feedback to Humana, Careplus, Wellcare and Coventry and working through daily authorization requests when information is missing.
Create process for managing requests when patients need to see the primary care provider by coordinating with primary care provider and Market leaders.
Enable a member of PMR network or clinical team to reach out to authorization requester when deemed necessary.
Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible one dependent on market needs.
Travel as needed to PMR & ChenMed markets for training and support.