SUMMARY:
The Care Specialist oversees daily workload of the Care Coordinators within the Care Management Department. The incumbent will possess effective technical and decision making skills and will offer guidance to the Care Coordinators using a team-based approach. Practices in accordance with HNE policies and procedures and will be considered an expert on care coordination for all HNE lines of business in order to provide efficient and effective assistance to HNE members.
ESSENTIAL FUNCTIONS:
Care Coordinator Oversight Responsibilities- 40%
Develops a strong understanding of and comprehends the nuances between all lines of business
Adjusts daily workflows for the team as necessary based on volume and staffing
Coordinates Care Managers' and Social Workers' Referrals Queue
Provides insights into the Care Coordinator position in order to assist Integrated Care Supervisor to create productive and efficient workflows
Tracks and orders educational materials for the department
Offers support for orientation and education for care coordinators
Presents at meetings as appropriate
Assists Integrated Care Supervisor as needed
Member Support and Education 60%
Initiates outreach and screening for case management and disease management programs
Reviews MBHP reports and refers RC1 members to HFI as appropriate
Assesses High Cost/Utilizer lists, identifies members that are or should be enrolled in CCM High or DM Programs and either outreached to members or delegates the task to Care Coordinators
Documents assessments, education and outreach attempts in Aerial as per HNE policies and procedures.
Manages CM Referrals from fax press
Assists Care Coordinators as necessary
Performs Care Coordinator responsibilities including BeHealthy Maternity Program
MINIMUM REQUIREMENTS:
High School diploma or equivalent (associates degree preferred) and more than 3 years of progressively responsible experience in a medical administrative role in a physician's office, clinic or other medical facility or the insurance industry.
Experience with and/or specific training in medical terminology
Some experience in a lead capacity preferred
Excellent computer skills, including ability to use of multiple systems such as EMR, Microsoft Office products
Typing speed and accuracy
Knowledge of VISIO
Problem solving, organizational and prioritizing skills
Ability to effectively interact with a multi-cultural membership
Ability to communicate effectively with others, on the telephone and in person
Excellent verbal and written communication skills (Bilingual preferred)
Strong teamwork skills, ability to work collaboratively with team members
WORKING CONDITIONS : Works in a standard office-based environment
Receive real-time job alerts and never miss the right job again
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