Medical Management Coordinator

Job Purpose

The Medical Management Coordinator works collaboratively with team members and independently to provide care management to HealthTexas members. In addition, the role contributes to the growth and success of HealthTexas while upholding the organization’s Mission, Vision, and Values.

Culture and Values Expectations

At HealthTexas, workplace culture is the cornerstone of success. Associates are expected to embody and promote the following values:

• Integrity: Do the right thing, the right way, every time. Be honest, uphold commitments, earn trust and respect, and maintain privacy and confidentiality.
• Compassion: Treat everyone with respect and dignity. Foster inclusivity and well‑being, practice patience and empathy, and assume positive intent.
• Synergy: Collaborate to improve outcomes. Invite and explore new opportunities, promote effective communication and teamwork, and take pride in yourself, your work, and HealthTexas.
• Stewardship: Use resources responsibly and efficiently. Implement effective strategies to attain goals, achieve maximum productivity and results, and seek continuous knowledge and improvement.

Essential Duties & Responsibilities

• Establish and maintain professional rapport with providers, members, and other team members.
• Attend departmental meetings.
• Participate in Medical Director Review meetings by discussing patients after telephonic contact.
• Review daily census and assist with follow‑up tasks as needed.
• Outreach telephonically to patients after hospitalization to complete transitional case management.
• Schedule office visits for patients after hospitalization, ensuring they are seen by a Primary Care Provider (PCP) within 7‑14 days.
• Outreach telephonically to patients who have had a recent Emergency Room visit and schedule a follow‑up appointment with a PCP or APC within 7 days.
• Outreach telephonically to patients to provide education.
• Obtain hospital records from various portals and input them into patients’ medical records.
• Mail information to patients and providers; fax information to providers.
• Communicate with PCPs and specialists as needed.
• Obtain medical records from specialty visits and input them into the ECW system.
• Maintain accuracy of specific spreadsheets on a daily basis.
• Respond to telephone encounters in the medical system in a timely manner.
• Comply with all guidelines established by the Centers for Medicare and Medicaid Services (CMS), if applicable.
• Other duties assigned by the director and/or supervisor.

Experience

• Minimum of 1 year healthcare experience providing care to a managed‑care population.
• Experience with an Electronic Medical Record (EMR) system.
• Intermediate proficiency with Microsoft Word, Excel, PowerPoint, and Outlook.

Education

• High school diploma or equivalent.
• Current Medical Assistant Certification preferred.

Knowledge, Skills & Abilities

• Knowledge of medical management concepts preferred.
• Professional verbal and written communication skills; ability to clearly articulate thoughts and ideas.
• Excellent telephonic customer service skills.
• Self‑starter who is successful with minimal supervision.
• Typing speed of at least 40 wpm.

Schedule

Monday – Friday, 8:00 a.m. – 5:00 p.m., and as needed to complete projects.

Travel Requirements

Travel to medical offices may be necessary for the purpose of providing benefit education.

Working Conditions & Physical Requirements

This role operates in an office setting and routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets, and fax machines. The position is largely sedentary but requires occasional filing, lifting of files, opening filing cabinets, and standing on a stool as necessary. The employee must regularly talk and hear, and possess the following vision abilities: close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.