CARE MANAGEMENT COORDINATOR

BRMS•Folsom, CA

just now

About The Position

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.

Requirements

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.
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 7 am to 5 pm, Mon- Fri.

Nice To Haves

Durable Medical Equipment knowledge preferred.

Responsibilities

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.