Member Care Coordinator

Community Care of North Carolina Inc•New Caledonia, AR

36d•Remote

About The Position

The Member Care Coordinator position is a non-clinician role that works in collaboration with the Care Management staff and/or quality improvement staff to support the multi-disciplinary team approach of patient care by meeting key performance indicators (closing care gaps, reducing hospitalizations, readmissions, ED utilization, and PMPM costs) and other organizational mandates as designated. The Member Care Coordinator may work remotely within regions to cover the needs across the state and/or may work on site at CCPN practices. Member Care Coordinators may directly assist members in improving their ability to improve their health outcomes. They also help design and implement systems to ensure the smooth operation of office functions and to support the Care Team. Member Care Coordinators may also work directly with assigned practices to assist them in addressing care gap closure under the direction of Provider Relations Representatives. THIS IS PRIMARILY A REMOTE POSITION. OCCASIONAL IN-PERSON TRAINING AND TRAVEL MAY BE REQUIRED.

Requirements

High school diploma or GED required; or Licensed Practical Nurse
2-4 years minimum experience in a health care setting required
Maintain a valid driver’s license with current auto liability insurance
Knowledge of and experience working in patient or clinical data systems
Computer skills required including various office software and the internet; experience with MS Office software preferred
Knowledge of state and federal benefits system
Excellent communication skills – oral and written
Proficient Motivational Interviewing skills
Organizational and time management skills
Sensitivity to diversity of cultures, language barriers, health literacy and educational levels
Knowledge of medical terminology
Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives
Able to shift strategy or approach in response to the demands of a situation

Nice To Haves

2- or 4-year degree in health-related field preferred
Bilingual preferred

Responsibilities

Receive and document all referrals from various sources into the Care Management documentation platform
Verify eligibility and demographic information
May complete Health Risk Screenings as needed
Assist with mailing of educational materials, consent forms or other documents to the member as necessary
Assist with referrals on behalf of the Care Management team
Provide information for access and coordination of resources
Assist member with care coordination and health care system navigation
Provide culturally appropriate health education and information
Provide general education and social support
Advocate for members
Identify care gaps and perform outreach to members in attempt to close gaps as requested
Assist practice to submit supplemental data to health plans to provide documentation of gap closure as requested; assist with scheduling medical appointments and transportation as needed
Assist to address with Social Determinants of Health as needed
Access multiple EHR’s to obtain and upload into the care management platform
Access to Hospital/Data or Electronic Medical Record system will be required, as necessary
Notify supervisor promptly of any issues with carrying out any duties assigned
Adhere to CCNC Privacy and Security policies to ensure that patient and company data is properly safeguarded
Abide by department guidelines, company policies, and HIPAA regulations
Perform other duties that assist in keeping the operations organized and functional
Attend Departmental and corporate meetings, local and regional training, or other events as required
Understand and uphold CCNC goals, objectives, and standards
Travel using a personal vehicle will be required within the region and/or the State