Care management Coordinator - St. Joseph Health (California)
Job Summary: Under the direction of the Supervisor or Manager, this position is responsible for providing support to the Care Management team who coordinates care for identified members/patients throughout the healthcare continuum. This position works closely as a healthcare team member and performs clerical tasks related to the overall team functions and activities identified during the initial and ongoing assessment and management of members/patients.
Essential Values-Based, Competencies: Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by employees in order to achieve the Mission of the St. Joseph Health System.
Dignity: Demonstrates competence in communication and interpersonal relations.
Excellence: Demonstrates competence in continuous improvement, continuous learning, accountability, and teamwork.
Service: Demonstrates competence in customer/patient focus and adaptability.
Justice: Demonstrates competence in community orientation and stewardship.
As defined on the attached Values-Based Competency Model Form.
Essential Functions:
• Coordinates referrals based upon business rules, payor/government regulations, complexity of member/patient, care management admission.
• Initiates telephone, fax or internet contacts with payors, post-acute and/or community resources. Determines availability of services specified. Facilitates transportation as necessary.
• Assists team as directed to ensure comprehensive discharge planning throughout the healthcare continuum facilitating communication throughout all access points and all members of the healthcare team, including the health plans contacts, facility discharge planners/case managers, providers in network and out of network and other appropriate contacts.
• Demonstrates excellent communication skills. Documents communication of information to and receipt of information from all members of the healthcare team, including payors and post-acute providers as required. Enters authorization number and pertinent data into the information system as assigned.
• Provides secretarial and clerical duties for the Department.
• Reviews reports to assist with identifying appropriate patients .Maintains work lists as appropriate.
• Assist in determining of appropriate coverage including hospitalization, DME, out-pt. medications, etc., obtaining authorizations as needed. Enters all authorizations into IT systems as required.
• Tasks Primary Care Provider (PCP) or other members of the healthcare team, as appropriate regarding member/patient regarding UM or CM concerns.
• Phone or fax clinical review to payors or providers as directed and provides follow up to support avoidance of denials.
• Participates as a team member and communicates effectively with the health care team.
• Responds to calls for information from payers, and follows up on existing payer request. Contacts appropriate care manager as required.
• Participates in staff meetings and other interdisciplinary meetings.
Additional Responsibilities:
• Performs all other duties as assigned.
Information Management: Treats all information and data within the scope of the position with complete confidentiality and security. Maintains all practices to protect PHI and follows to HIPAA guidelines.
Risk Management: Cooperates fully in all risk management activities and investigations.
Safety Requirements: Is knowledgeable of, observes and complies with Codes of Safe Practice, safety policies and emergency procedures.
Age-Related Competencies:
• Human development knowledge/skills:
Demonstrates the knowledge and skills necessary to coordinate care appropriate to the age of the patients served including knowledge of the principles of growth and development and psychosocial characteristics and interventions for any age member of our network.
• Age-specific patient needs that employee is required to understand and meet:
Demonstrates the ability to gather and interpret age appropriate data about the member’s status in order to identify age-specific needs and coordinate the care needed.
• Additional requirements:
Demonstrates age appropriate communication skills for the patient population served.
Demonstrates knowledge of age-specific community resources.
Minimum Position Qualifications:
Education:
• High school diploma or GED required.
Experience:
Requires one (1) one year healthcare experience
Computer Skills: Basic computer skills in a Windows operating environment including, Microsoft Word
Other:
• Completion of Medical Terminology coursework or possess working knowledge of Medical Terminology.
Knowledge / Skills / Abilities:
• Knowledge of or ability to learn Mcg Care Guidelines application, Touchworks, IDX, Word, Excel, Meditech
• Knowledge of utilization management, case management and healthcare provided throughout the continuum.
• Ability to handle multiple tasks at a time and remain organized.
• Ability to work autonomously but also as a team member.
• Ability to manage data and generate reports using current computer programs.
• Ability to plan, organize, prioritize, work independently and meet deadlines.
• Ability to work as a contributing member of an interdisciplinary team.
Preferred Position Qualifications:
Education: Associate’s degree in a related field preferred.
License / Certification:
• MA certificate
Experience:
• Managed care or case management experience highly desirable.
• Prior experience with Mcg Care Guidelines, Touchwork, IDX, Meditech
Computer Skills:
• Proficient in all Microsoft Office applications including Word and Excel.
• Previous experience with Allscripts, Touchwork, Meditech, Enterprise and/or IDX experience highly
desirable.
Other: Bilingual English/Spanish communication skills.
Environnemental Conditions: May include exposure to potentially hazardous material, infectious agents, contact with patients, public, and staff.
Physical Requirements: Sitting for long periods of time, bending, reaching, stooping, kneeling, pushing/pulling, lifting/carrying up to 20 lbs., and grasping. Ability to travel between St. Joseph Health locations.
St. Joseph Heritage Healthcare (SJHH) is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, SJHH has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values.St. Joseph Heritage Healthcare (SJHH) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Joseph Heritage Healthcare (SJHH) complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Company: Heritage Healthcare
