Care Management Coordinator

Position Summary :

The Care Management Coordinator works in conjunction with a multi-disciplinary team within an assigned ambulatory / outpatient clinical setting to support the implementation and ongoing patient care plan / continuum treatment. Provides accurate and timely non-clinical administrative support. Coordinates all aspects of the patient referral process, collaborating with patients and families, providers, and community resources according to established guidelines.

Key Responsibilities :

• Independently processes referrals for care management including, but not limited to, medications, skilled and private duty nursing, infusion and enteral therapy services, durable medical equipment and supplies, Home Care Agencies : Early Intervention Program (EIP), Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP) and transportation throughout the care continuum.
• Review daily work assignments and priorities to ensure critical requests are addressed.
• Collaborate and delivers clear, effective communication with multidisciplinary team members to coordinate care management activities within the assigned ambulatory / outpatient clinical setting.
• Work with insurances companies to obtain prior authorization approvals. Assist clinical team in coordinating pursuing denial / appeal process if needed. Plan and prioritize the coordination and tracking of the prior authorization renewal process.
• Serve as a liaison, working in conjunction with licensed clinical providers within assigned areas to ensure regular, and fluid communication with relevant clinical and non-clinical groups is ongoing by establishing connectivity between all areas throughout the care continuum process.
• Assist patients and families with inquiries, provide resources, educational literature, and direct them to community partners. Provide a high level of services and support. Assist with status regarding urgent or emergent requests and other inquiries.
• Coordinate medication prescription requests including but not limited to prior authorizations, verbal overrides, setting up specialty pharmacy accounts, verifying copays and exploring assistance options, referring to Social Work or assisting with Free Care if needed.
• Coordinate extensive worklist of patient requests to ensure timely submission, approval, and follow up of all requests.

Minimum Qualifications

Education :

Experience :

The posted pay range is Boston Children’s reasonable and good-faith expectation for this pay at the time of posting.

Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.