Member Care Coordinator

Job Description

Job Description

Position Summary

The Member Care Coordinator position is a non-clinician role that works in collaboration with the Care Management staff and / or quality improvement staff to support the multi-disciplinary team approach of patient care by meeting key performance indicators (closing care gaps, reducing hospitalizations, readmissions, ED utilization, and PMPM costs) and other organizational mandates as designated. The Member Care Coordinator may work remotely within regions to cover the needs across the state and / or may work on site at CCPN practices.

Member Care Coordinators may directly assist members in improving their ability to improve their health outcomes. They also help design and implement systems to ensure the smooth operation of office functions and to support the Care Team.

Member Care Coordinators may also work directly with assigned practices to assist them in addressing care gap closure under the direction of Provider Relations Representatives.

This is primarily a remote position. Occasional in-person training and travel may be required.

Essential Functions

• Receive and document all referrals from various sources into the Care Management documentation platform
• Verify eligibility and demographic information
• May complete Health Risk Screenings as needed
• Assist with mailing of educational materials, consent forms or other documents to the member as necessary
• Assist with referrals on behalf of the Care Management team
• Provide information for access and coordination of resources
• Assist member with care coordination and health care system navigation
• Provide culturally appropriate health education and information
• Provide general education and social support
• Advocate for members
• Identify care gaps and perform outreach to members in attempt to close gaps as requested
• Assist practice to submit supplemental data to health plans to provide documentation of gap closure as requested; assist with scheduling medical appointments and transportation as needed
• Assist to address with Social Determinants of Health as needed
• Access multiple EHR’s to obtain and upload into the care management platform
• Access to Hospital / Data or Electronic Medical Record system will be required, as necessary
• Notify supervisor promptly of any issues with carrying out any duties assigned
• Adhere to CCNC Privacy and Security policies to ensure that patient and company data is properly safeguarded
• Abide by department guidelines, company policies, and HIPAA regulations
• Perform other duties that assist in keeping the operations organized and functional
• Attend Departmental and corporate meetings, local and regional training, or other events as required
• Understand and uphold CCNC goals, objectives, and standards
• Travel using a personal vehicle will be required within the region and / or the State

Qualifications

Preferred Qualifications

Knowledge, Skills, and Abilities

Working Conditions