Care Management Service Coordinator

This individual must be able to plan, organize, and prioritize work to ensure completion in a timely manner. He/she functions as a key contact and department representative of the Point32Health Senior Products Care Management Community values to both internal and external customers of the care management department through both verbal and written communications.

Under the administrative direction of the Supervisor of Administration, the Care Coordinator (CC) performs activities that support the clinical, business and program related work of the case managers (CM) and the management team. The Care Coordinator is a key member of the case management team who performs complex administrative duties, adjunct to the role of the case manager with minimal supervision.

Key Responsibilities/Duties – what you will be doing

Support the General Case Management Process within Case Management Department:

Initiates requests for clinical information from inpatient providers within department timelines Accurately identifies when to escalate issues which may prevent meeting department timelines for completion of notification to providers for denials and for requests for information

Track and manage member needs within the defined intervention period for the member specific population, complete follow-up responsibilities within required timeframe

Provide education and coaching to the member, family, and/or caregiver about follow up care and health status, goals of transition care, and health insurance benefits to assist members in making the most informed decisions and to promote self-management of care

Ensure timeliness in coordination of health care services. Assist members with scheduling appointments, tests, screenings, and transportation.

Assist execution of special projects and outreach campaigns

Under direction of registered nurse, influence course of care

Performs general office duties:

Such as sorting departmental mail, filing, faxing, photocopying, researches addresses / member contact information as necessary when typing labels and envelopes. Manages and assures adequate Disease Management material mailing inventory. Employ multi-tasking skills when multiple deliverables are due

Sorts copy requests separating Copy Center requests from routine jobs. Completes all Copy Center Request forms and submits to the Copy Center for large copy production jobs. Follows-up with the Copy Center on rush jobs. Copies and distributes small copy requests.

Organize copies of documents in binders and/or prepare for mailings.

Central Contact for Nurse Practitioners for HMO/SCO:

Calls members to setup NP assessments utilizing the language line as needed

Scheduling translation services for in home visits by NPMaintains calendar of NP assignments, communicates according to policy

Accurately identifies any issues to escalate to a Team Leader

Provides departmental process support in duties unique to assigned service operations area.

Attends scheduled meetings and assigned training sessions.

Qualifications – what you need to perform the job

High School degree required. Associates degree in business and/or completion of Medical Assistant/Medical technology/LPN program is highly desirable. Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts.

Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Talent

Boost is now Ignyte AI.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law

Req ID:

R6727