Care Management Coordinator II

Moda Health•Milwaukie, OR

13d•Remote

About The Position

Provide support to the Healthcare Services Case Management team by assisting in the monitoring and review of all tiers of care coordination. Supports the Moda Clinical Care Team by assisting in member engagement through outreach campaigns, collecting member-specific health data, documenting member outreach/engagement, and data entry. The coordinator utilizes their clinical healthcare experience to navigate member needs and develop care plans directed towards improving member health outcomes. Completes reviews of annual and periodic health risk assessment surveys on members and provides reportable information to the supervisor for yearly reporting as appropriate. This is a FT WFH position.

Requirements

2 - 4 years of experience in a medical office and/or case management experience required
Community/Traditional Health worker certification or Bachelor of Social Work (BSW) required
Proficient in Microsoft Office applications
Type a minimum of 35 wpm
Excellent written, verbal and interpersonal communication skills
Excellent organizational and detail orientation skills
Must present a professional business image in all settings
Ability to work well under pressure, work with frequent interruptions and shifting priorities
Strong problem-solving skills and critical thinking required
Ability to work independently, as well as part of a team, dealing with all levels of staff, members, providers, in a professional manner
Demonstrates professionalism, empathy, and discretion when working with patients, caregivers, and medical staff; adheres to HIPAA regulations.
High level of understanding of medical terminology, state and federal regulations and social determinates of health and equity
Knowledge of health plan benefits
Familiar with CMS (Medicare/Medicaid) rules and regulations

Responsibilities

Initiates mailing campaigns to encourage case management engagement.
Research social determinants of health and equity needs that affect members and develop processes to enroll these members in case management services.
Reviews related referral and care plans monthly to meet compliance requirements.
Coordinate and initiate referrals to appropriate services and programs utilizing a large network of resources to assist member needs
Assists with triage of Health-Related Services funds requests
Collect information about a member’s social, clinical, and functional status to identify individual and case management needs.
Create, enter, and complete Health Risk Assessments and initiate appropriate care plans within the members health record.
Collaborate with RN Case Managers to initiate referrals, communicate specific member needs, and to assist in care planning.
Communicate effectively with other Medical Management support staff.
Analyze claims and encounters to identify high utilization members that would benefit from higher care coordination services.
Effectively uses the Moda Health systems to accurately determine eligibility, benefit plan, and physician networks associated with the member’s plan.
Utilizes the Moda Health systems for documentation of contact with providers and members.
Performs outreach calls to inform patients about care coordination services and start case workflows.
Ensure adherence of Health Insurance Portability and Accountability Act (HIPPA) and other regulatory guidelines including privacy and security.
Identifies member needs and research alternative solutions.
Completes other duties and special projects as assigned by the CM Supervisor and/or the HCS Manager.