Care Management Coordinator III (2 Open Positions)

Job Summary

The Care Management Coordinator III serves as the primary liaison for the Department of Health Services (DHS) Emergency Department (ED) Coordination of Care Process and is responsible for the coordination of urgent complex member needs. This position ensures timely case opening, provider and member outreach, and facilitation of specialty authorizations. The Care Management Coordinator III works independently to ensure loop closure with DHS facilities and required documentation for program tracking. This position serves as the subject matter expert on DHS ED referral processing, authorization coordination and responsible for providing guidance to Care Management Coordinator IIs as needed. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

Duties

Serves as the primary case owner for high-risk, complex members requiring intensive and ongoing services. Conducts timely telephonic outreach, case identification, thorough documentation, investigation and resolution of complex cases and follows up with providers, Participating Physician Groups (PPGs) and other departments on behalf of assigned members. (40%)    

Responsible for the timely, end to end management of care coordination of DHS cases, including obtaining specialty authorizations, scheduling appointments, initiating the coordination of referrals to internal departments and external community resources, ensuring accurate and compliant documentation, managing computer data input, secure communications, and the organization of confidential member information, as well as maintaining logs of activity, etc. (30%)

Assigns cases to a Care Management Specialist to assist with care coordination and outreach for high-risk and complex members. Facilitates, documents, schedules and organizes Interdisciplinary Care Team meetings, manages regulatory notifications by monitoring utilization trends and initiating timely communication with Primary Care Physician (PCP), PPG and members during a transition of care. (15%)

Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed. (5%)

Performs other duties as assigned. (10%)

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 2 years of experience in healthcare/managed care, or medical administration.

At least 6 months of experience working on care coordination cases directly with members and providers.

Preferred: 

At least 6 months of experience processing authorizations at a managed care or health plan setting.

Skills

Required:

Advanced knowledge of medical terminology.

Knowledge of health care regulations, and policies and procedures.

Excellent verbal and written communication skills.

Advanced proficiency in Microsoft Office with a high level of accuracy.

Excellent analytical and conflict resolution skills as well as persuasion skills.

Excellent organizational and time management skills.

Highly detail-oriented and a team player.

Excellent customer service skills with compassion and empathy.

Ability to work with minimal supervision using excellent critical thinking skills.

Knowledge of utilization management and authorization process.

Preferred:

Not Applicable

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Required:

Motivation Interviewing 

Preferred:  

Trauma Informed Care

Physical Requirements

Additional Information