Care Coordinator

WellSense Health Plan•Remote,

5h•$20 - $29•Remote

About The Position

Performs telephonic outreach and assessment of identified populations and provides coordination of community resources and support to Members and Providers across service areas. Identifies, facilitates, coordinates and advocates for Member access to services that enhance healthcare access and delivery by assisting in the coordination of safety net services that provide for basic needs such as education, housing, healthcare, legal, transportation and counseling assistance. Facilitates the acquisition of medications for patients to ensure compliance with medication regimens. Influences member engagement rates utilizing Motivational Interviewing skills and persuades Members to participate in Plan sponsored care management activities. Triages for and collaborates with clinical staff to ensure Members receive appropriate care. Supports one of the following care management programs: Sunny Start, Transition to Home, Population Health Management or Complex Care Management.

Requirements

Associate’s degree or High School Diploma/equivalent and relevant work experience required.
2 years of office experience, specifically in either a high volume data entry office, customer service calls center, or health care office administration department.
Motivational Interviewing skills
Strong oral and written communication skills
Ability to effectively collaborate with health care providers and all members of the interdisciplinary team
Demonstrated strong organizational and time management skills
Able to work in a fast paced environment and multi task
Experience with Microsoft Office application, particularly MS Outlook and MS Word and other data entry processing applications
Successful completion of pre-employment background check

Nice To Haves

Knowledge and experience in maternal child health.
Experience with FACETS/JIVA or other healthcare database.
Experience with care coordination or case/care management
Prior customer service experience.
Knowledge of medical terminology strongly preferred
Knowledge of community resources strongly preferred

Responsibilities

Supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate.
Assesses member needs by conducting interviews and structured assessments using Motivational Interviewing techniques to engage Members and determine non-clinical and social needs and engage them in care management.
Educates members by providing information on how to obtain resources, basic health information and by sending information packets to Members containing health information relative to the Member’s identified conditions.
Maintains current knowledge of community resources for referral and linkage to meet Members’ needs
Participates in group meetings to ensure policies, procedures, and work flows are up to date and advises on revisions needed.
Facilitates member communication with external partners such as state agencies, community based organizations, clinical vendors, and primary care and specialty practices.
Completes documentation in the medical management information system [JIVA] in a timely manner and in keeping with contractual requirements, internal policy and accreditation standards.
Complies with established metrics for performance, adheres to documentation and work flow standards and utilizes other department specific tracking tools.
Triages cases to clinical staff, other departments, contracted vendors and providers as appropriate.
Participates as assigned in answering calls on the care management 800 line
Runs TTH census report admissions with TTH with Match Report and removes program ineligible members.
Creates cases in JIVA and checks for discharge dates in JIVA by referencing the facility census or by contacting the facility.
Telephonically outreaches to select full program members
Calls short program members to ensure an appointment with the PCP or specialist has been set up within a week of discharge and assists member in making appointments as needed.
Supports members to access necessary equipment such as breast pumps and infant car seats within members benefit structure
Facilitates member access to and completion of prenatal and postpartum visits according to best practice guidelines and workflow standards.