Coordinator - Care Management
Rancho Cucamonga, CA Rancho Cucamonga, CA Estimated:
$55.
4K - $70.
1K a year Estimated:
$55.
4K - $70.
1K a year Job Requisition ID:
9827 Position Summary/Position Under the general supervision of the Care Management (CM) Manager and direct supervision of the CM Coordinator Supervisor, the CM Coordinator is responsible for advocating, facilitating and supporting care management activities.
Major Functions (Duties and Responsibilities) 1.
Responsible for assisting Members with care coordination in respect to referral process such IPA for Durable Medical Equipment (DME), home health, and Specialist needs.
2.
Responsible for assisting with the referral process by contacting providers by phone, fax, or email to request additional medical information as needed.
3.
Responsible for assisting the Care Managers in the management and coordination of care of Member identified with care management conditions.
4.
Responsible for facilitating Member care to ensure that a continuity of care letter of agreement (LOA) is executed when appropriate.
5.
Collaborates on Member's care issues with other team members and consults with NCM or CM supervisor to ensure that appropriate treatment plan is followed, thoroughly and promptly.
6.
Responsible for processing and coordinating divorces, disenrollment, transportations, and language interpretation as needed and applicable.
7.
Assists with contact calls for monthly HRA pull, i.
e.
, Complex Case Management and assisting with coordinating the members overall care as needed.
8.
Responsible for identifying HEDIS gaps and contacting the member to address these gaps.
9.
Responsible for covering Cisco ACD Queue telephone lines and Phone queue.
10.
Assists with the coordination of access issues with PCP offices, specialists, radiology services and ancillary services such as PT, OT, speech therapies.
11.
Ensures documentations is accurate and in compliance with regulatory requirements and accreditation standards.
12.
Consults with assigned nurses for clinical assessment and decision prior to taking action that are clinical in nature.
13.
Performs any other duties as assigned or required to ensure Health Plan operations are successful.
14.
Participates in Medical Services staff meetings or other activities as needed 15.
Ensures the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance including attending annual compliance training.
16.
Promotes a positive and collaborative working environment within the CM Team.
Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leading:
Self Experience Qualifications Two (2) years customer service experience in medical clinics, hospitals, or IPAs.
Preferred Experience Managed care setting experience preferred.
Education Qualifications High school diploma or GED required.
Preferred Education Associate's degree or Bachelor's degree from an accredited institution preferred.
Professional Certification Medical Assistant Certification preferred.
Professional Licenses Drivers License Required No Knowledge Requirement Knowledge of Utilization Management including referral process, ICD-10 and CPT codes preferred.
Knowledge of utilization management process and care coordination in HMO or managed care setting.
Knowledge of Medi-Cal, and Medicare managed care.
Understanding of and sensitivity to multi-cultural community.
Skills Requirement Excellent written and verbal communication and interpersonal skills.
Strong organizational skills, typing 45 words per minute, proficient in Windows applications.
Experience in data entry.
Abilities Requirement Team culture is a must.
Telephone courtesy and high degree of patience.
Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture.
A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working Conditions Communication with IEHP Members, which includes intensive telephone use, basic computer knowledge and word processing/data entry skills including computer keyboard and screens, distribution of reports, filing and copying of records and/or correspondence.
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval.
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model Location Hybrid Physical Requirements Hearing:
One-on-One - FREQUENTLY Communicate:
Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY Regular contacts:
co-workers, supervisor - FREQUENTLY Keyboarding:
10-Key - FREQUENTLY Keyboarding:
Touch-Screen - FREQUENTLY Keyboarding:
Traditional - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY A reasonable salary expectation is between $45,884.
80 and $55,993.
60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire.
We are also one of the largest employers in the region, designated as Great Place to Work.
With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.
5 million members.
And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we're ready to make a difference today and in the years to come.
Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
$55.
4K - $70.
1K a year Estimated:
$55.
4K - $70.
1K a year Job Requisition ID:
9827 Position Summary/Position Under the general supervision of the Care Management (CM) Manager and direct supervision of the CM Coordinator Supervisor, the CM Coordinator is responsible for advocating, facilitating and supporting care management activities.
Major Functions (Duties and Responsibilities) 1.
Responsible for assisting Members with care coordination in respect to referral process such IPA for Durable Medical Equipment (DME), home health, and Specialist needs.
2.
Responsible for assisting with the referral process by contacting providers by phone, fax, or email to request additional medical information as needed.
3.
Responsible for assisting the Care Managers in the management and coordination of care of Member identified with care management conditions.
4.
Responsible for facilitating Member care to ensure that a continuity of care letter of agreement (LOA) is executed when appropriate.
5.
Collaborates on Member's care issues with other team members and consults with NCM or CM supervisor to ensure that appropriate treatment plan is followed, thoroughly and promptly.
6.
Responsible for processing and coordinating divorces, disenrollment, transportations, and language interpretation as needed and applicable.
7.
Assists with contact calls for monthly HRA pull, i.
e.
, Complex Case Management and assisting with coordinating the members overall care as needed.
8.
Responsible for identifying HEDIS gaps and contacting the member to address these gaps.
9.
Responsible for covering Cisco ACD Queue telephone lines and Phone queue.
10.
Assists with the coordination of access issues with PCP offices, specialists, radiology services and ancillary services such as PT, OT, speech therapies.
11.
Ensures documentations is accurate and in compliance with regulatory requirements and accreditation standards.
12.
Consults with assigned nurses for clinical assessment and decision prior to taking action that are clinical in nature.
13.
Performs any other duties as assigned or required to ensure Health Plan operations are successful.
14.
Participates in Medical Services staff meetings or other activities as needed 15.
Ensures the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance including attending annual compliance training.
16.
Promotes a positive and collaborative working environment within the CM Team.
Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leading:
Self Experience Qualifications Two (2) years customer service experience in medical clinics, hospitals, or IPAs.
Preferred Experience Managed care setting experience preferred.
Education Qualifications High school diploma or GED required.
Preferred Education Associate's degree or Bachelor's degree from an accredited institution preferred.
Professional Certification Medical Assistant Certification preferred.
Professional Licenses Drivers License Required No Knowledge Requirement Knowledge of Utilization Management including referral process, ICD-10 and CPT codes preferred.
Knowledge of utilization management process and care coordination in HMO or managed care setting.
Knowledge of Medi-Cal, and Medicare managed care.
Understanding of and sensitivity to multi-cultural community.
Skills Requirement Excellent written and verbal communication and interpersonal skills.
Strong organizational skills, typing 45 words per minute, proficient in Windows applications.
Experience in data entry.
Abilities Requirement Team culture is a must.
Telephone courtesy and high degree of patience.
Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture.
A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working Conditions Communication with IEHP Members, which includes intensive telephone use, basic computer knowledge and word processing/data entry skills including computer keyboard and screens, distribution of reports, filing and copying of records and/or correspondence.
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval.
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model Location Hybrid Physical Requirements Hearing:
One-on-One - FREQUENTLY Communicate:
Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY Regular contacts:
co-workers, supervisor - FREQUENTLY Keyboarding:
10-Key - FREQUENTLY Keyboarding:
Touch-Screen - FREQUENTLY Keyboarding:
Traditional - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY A reasonable salary expectation is between $45,884.
80 and $55,993.
60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire.
We are also one of the largest employers in the region, designated as Great Place to Work.
With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.
5 million members.
And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we're ready to make a difference today and in the years to come.
Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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