Alignment Health is seeking a bilingual Spanish remote care coordinator to join the special needs plan (SNP) case management team. The SNP team is responsible for the health care management and coordination of care for members with complex and chronic care needs. As a care coordinator, will be responsible for case management coordinator functions for the SNP membership and get to support members with closing care gaps and addressing care coordination needs as directed by the RN Case Manager. You will collaborate with the RN case manager as part of the interdisciplinary team.
Responsibilities:
Reach out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc
Create cases, task, and complete assessments in case management module for all hospital and SNF discharges
Complete and document tasks assigned by case manager.
Work as a team with the case manager to engage and manage a panel of SNP members
Manage new alerts and update case manager of change in condition, admission, discharge, or new diagnosis
Establish relationships with members, earn their trust, and act as patient advocate
Escalate concerns to nurse if members appear to be non-compliant or there appears to be a change in condition
Assist with outreach activities to members in all levels of case management programs.
Assist with maintaining and updating member's records
Assist with mailing or faxing correspondence to members, PCP's, and/or Specialists
Request and upload medical records from PCP's, Specialists, Hospitals, etc., as needed
Attend interdisciplinary team meetings and participate in member presentations as appropriate.
Meet specific deadlines (respond to various workloads by assigning task priorities according to department policies, standards and needs)
Maintain confidentiality of information between and among health care professionals
Required Skills and Experience:
Experience working with IPAs
Experience entering referrals and prior authorizations
Experience with Access Express / Portal, Epic, Essette preferred
Knowledge of Managed Care Plans
Knowledge of Medi-Cal
High school diploma or general education degree (GED); with one to three months related experience and / or training; or equivalent combination of education and experience
Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Communicates effectively using good customer relations skills. Able to file systematically
Able to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Able to perform these operations using units of American money and weight measurement, volume, and distance.
Able to apply common sense understanding to carry out detailed but uninvolved written or verbal instructions. Able to deal with problems involving a few concrete variables in standardized situations. Able to reason and carry out instructions.