Care Coordinator at Alignment Healthcare USA, LLC in Orange, California

Job Description:

External Description:

The Care Coordinator is responsible for UM/CM Coordinator functions as defined below.

General Duties/Responsibilities (May include but are not limited to):

• Review Daily Census for new Admissions
• Obtain medical records from Provider offices, hospitals and SNF's
• Attach medical records to authorizations
• Enter referral requests/authorizations in system
• Monitor Fax Folders
• Monitor task lists in EHR
• Creates cases and tasks in Case Management module for Hospital and SNF discharges.
• Post discharge scheduling of appointments
• Follow up scheduling and re-scheduling of no-show appointments
• Assist NP team with visit preparation needs


• Appointment reminders to members
• Assign members to NP in EHR
• Enter all medications and allergies in EHR
• Provide needed documentation to NP for visits each day
• Direct inbound calls from members/family related to medication refills
• Assist in Hospice Enrollments
• Complies with tasks assigned by nurse and, as appropriate, documents accordingly.
• Maintains documentation on members contacted.
• Assists with COC's
• Notifies NP/nurse If members appear to be non-compliant or there appears to be a change in condition
• Assists with outreach activities to members in all levels of Case Management Programs.
• Assists with maintaining and updating member's records
• Assists with mailing or faxing correspondence to PCP's, Specialists, related to, as needed.
• Assists with mailing correspondence to members, related to CCIP activities, as needed.
• Attends Case Management presentations and participates, as appropriate.
• Recognizes work-related problems and contributes to solutions.
• Meets specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs).
• Works with outside vendors to provide appropriate care needs for members
• Maintains confidentiality of information between and among health care professionals.
• Other duties as assigned by CM Manager or Director of Case Management.
• Communication with multidisciplinary teams
• Covering for other team members when needed (i.e. PTO, sick time)

N/A

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Minimum Experience:
   
   
   1. Minimum 1 year front office medical assistant, related experience, and/or training; or equivalent combination of education and experience.
   2. Experience entering referrals and prior authorizations (highly preferred)
   
   
2. Education/Licensure:
   
   
   1. High school diploma or general education degree (GED)
   2. Medical Terminology Certificate preferred
   
   
3. Other:
   
   
   1. Knowledge of medical terminology
   2. Knowledge of ICD9 and CPT codes
   3. Knowledge of Managed Care Plans
   4. Computer proficient
   5. Able to type minimum 40 words per minute (WPM)
   6. Proficient in Microsoft Office (Outlook, Excel, Word)
   7. Bilingual English and either Spanish or Vietnamese required.
   8. Knowledge working in Access Express/Portal, Epic, Essette (not required)
   9. Good written, verbal, and telephonic communication skills
   10. Language Skills: 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.
   11. Mathematical Skills: 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.
   12. Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations.
   13. Good organizational skills
   14. Able to reason and carry out instructions.
   15. Good interpersonal skills.
   16. Read, write, and speak English fluently.
   17. File systematically.
   
   

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Internal Description:

The Care Coordinator is responsible for UM/CM Coordinator functions as defined below.

General Duties/Responsibilities (May include but are not limited to):

• Review Daily Census for new Admissions
• Obtain medical records from Provider offices, hospitals and SNF's
• Attach medical records to authorizations
• Enter referral requests/authorizations in system
• Monitor Fax Folders
• Monitor task lists in EHR
• Creates cases and tasks in Case Management module for Hospital and SNF discharges.
• Post discharge scheduling of appointments
• Follow up scheduling and re-scheduling of no-show appointments
• Assist NP team with visit preparation needs


• Appointment reminders to members
• Assign members to NP in EHR
• Enter all medications and allergies in EHR
• Provide needed documentation to NP for visits each day
• Direct inbound calls from members/family related to medication refills
• Assist in Hospice Enrollments
• Complies with tasks assigned by nurse and, as appropriate, documents accordingly.
• Maintains documentation on members contacted.
• Assists with COC's
• Notifies NP/nurse If members appear to be non-compliant or there appears to be a change in condition
• Assists with outreach activities to members in all levels of Case Management Programs.
• Assists with maintaining and updating member's records
• Assists with mailing or faxing correspondence to PCP's, Specialists, related to, as needed.
• Assists with mailing correspondence to members, related to CCIP activities, as needed.
• Attends Case Management presentations and participates, as appropriate.
• Recognizes work-related problems and contributes to solutions.
• Meets specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs).
• Works with outside vendors to provide appropriate care needs for members
• Maintains confidentiality of information between and among health care professionals.
• Other duties as assigned by CM Manager or Director of Case Management.
• Communication with multidisciplinary teams
• Covering for other team members when needed (i.e. PTO, sick time)

N/A

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Minimum Experience:
   
   
   1. Minimum 1 year front office medical assistant, related experience, and/or training; or equivalent combination of education and experience.
   2. Experience entering referrals and prior authorizations (highly preferred)
   
   
2. Education/Licensure:
   
   
   1. High school diploma or general education degree (GED)
   2. Medical Terminology Certificate preferred
   
   
3. Other:
   
   
   1. Knowledge of medical terminology
   2. Knowledge of ICD9 and CPT codes
   3. Knowledge of Managed Care Plans
   4. Computer proficient
   5. Able to type minimum 40 words per minute (WPM)
   6. Proficient in Microsoft Office (Outlook, Excel, Word)
   7. Bilingual English and either Spanish or Vietnamese required.
   8. Knowledge working in Access Express/Portal, Epic, Essette (not required)
   9. Good written, verbal, and telephonic communication skills
   10. Language Skills: 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.
   11. Mathematical Skills: 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.
   12. Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations.
   13. Good organizational skills
   14. Able to reason and carry out instructions.
   15. Good interpersonal skills.
   16. Read, write, and speak English fluently.
   17. File systematically.
   
   

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.