Care Coordinator

The Opportunity

The Care Coordinator supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Serves as a liaison alongside care managers and providers to ensure proper coordination of care for members and interacts with members by performing member outreach telephonically or through home-visits.

• Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate.
• Careers activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed.
• Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plans.
• Develops in-depth knowledge of care management services including responding to some complex or escalated issues.
• Communicate with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care.
• Support performing service assessments/screenings for members with some complex needs and documents the member’s care needs.
• Support documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed.
• Work with care management team triaging, adjusting, and escalating complex requests to management.
• Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards.
• Able to identify needs and make referrals to Care Manager, community case organizations, and Disease Manager.
• Follow up with the members who no longer meet the criteria for additional and intensive behavioral health services from the CCS program, and who are transitioned back to the base plan for BH services.
• Prepare and coordinate letters/correspondences to members, PCPs, and providers as requested by the Clinicians/ Supervisor/Manager.
• Aid in the generation and monitoring of utilization (UM) reports, BH reports, member service reports, HEDIS, QI reports, and claims resolutions.
• Participate in staff meetings and training, take minutes/attendance, and post on BH Share Point.
• Aid in the maintenance of Program related materials received from providers, as well as educational materials.
• Aid in the maintenance of claims review and or denial reconciliation when requested.
• Provide education on benefits and resources available.
• May assist with training and development needs.
• Comply with all policies and standards.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Maintain AlohaCare’s confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality.

  Requirements

  • High school diploma or equivalent
  • Minimum of 1 year of experience in related field
  • Experience working in behavioral health care or care coordination
  • Understanding the concepts of care coordination within the managed care field
  • Achieves results, builds trust, communicate effectively, customer and quality focused
  • Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization
  • Strong, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations
  • Professional telephonic etiquette skills
  • Able to solve problems, analyze, think critically, and make good judgments
  • Strong customer service skills and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills
  • Able to work independently with minimal supervision
  • Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment
  • Possesses excellent time management and organizational skills; dependable, enthusiastic, self-starting, and self-motivated
  • Uses time effectively, reacts professionally under pressure
  • Data entry experience with a high degree of accuracy and attention to detail
  • Working knowledge of Microsoft programs: Word, Excel, Outlook, and PowerPoint
  • Experience in the operation of general office equipment to include PC, fax/copy machine and phone system
  • Possession of valid driver’s license with access to a reliable insured automobile
  • TB Clearance
  • First Aid and CPR Certification