Enhanced Care Management Coordinator II

Job Summary

The Enhanced Care Management (ECM) Coordinator II provides a broad range of project and operational support to the Enhanced Care Management team.  This position is responsible for coordinating and organizing Enhanced Care Management activities, by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up. This position supports the Enhanced Care Management administration team in the monitoring and oversight process by collecting information, communicating with members, providers, and internal departments, and tracking program and compliance reports.

Duties

The Enhanced Care Management Coordinator II supports all administrative and technical functions of the Enhanced Care Management authorization process including intake, logging, tracking and status follow-up.

Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements; Computer Input: Accurately and completely process referrals/authorizations in the UM system of record; Identify duplicate requests using claims to verify existing authorization. Independently identifying and appropriately returning any file that is a duplicate to one already processed in the system; Appropriately documenting what information was used in making this determination within 4 hours of receipt. Appropriate identification and timely notification of time sensitive requests; Accurate Filing/Maintenance of confidential member information. Creating secure, complete, files. Interface with members, Enhanced Care Management personnel and other internal and external agencies; Ensure all referrals and authorizations comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete information i.e.: Population of Focus criteria, DX codes, CPT, HCPC codes. (40%)

Provide organizational and administrative support for Enhanced Care Management activities to help achieve desired goals. 

Plan and coordinate meetings, events, and related project activities to facilitate the optimal performance of Enhanced Care Management. Handles scheduling and coordination for stakeholder and provider meetings; correspondence, and follow up reports; compiles meeting materials; and maintains updated information on Enhanced Care Management. Assist with disseminating program communications to internal and external stakeholders. Provides assistance to team members as needed to achieve department goals. (30%)

Supports the Enhanced Care Management program administration team in the monitoring and oversight process.

Maintains the regular reporting responsibilities for Enhanced Care Management; tracks report timeliness, and notifies team of delays. Assists with soliciting information from providers concerning member cases and program operations for grievance and appeal requests. Provides non-clinical support to the Enhanced Care Management Clinical Specialist to support the provider oversight and review process (20%)

Performs other duties as assigned (10%)

Duties Continued

Education Required

Education Preferred

Experience

Required:
Minimum of 0-1 years of coordinator experience in health care/health services, with at least 1 year of experience in Medi-Cal managed care and/or as a Medical Assistant.

Skills

Required:

Knowledge of medical terminology, ICD-10, HCPCS and CPT codes.

Strong verbal and written communication skills.

Proficiency with Microsoft Outlook, Word, Excel, PowerPoint.

Excellent organizational, interpersonal and time management skills.

Must be detail-oriented and a team player.

Persuasion Skills: Must be able to interface with members, medical personnel, and other internal and external agencies. This includes persuading others to comply with L. A. Care requirements, and providing information in a timely fashion.

Preferred:

Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese  

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information