Job Description

Job Description

Job Description

Organizational Description

The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance. In order to help our health centers meet their missions of providing the best possible care to their communities, we also provide a broad range of training, technical assistance, quality improvement, information technology, and data analytic services.

Position Title: Care Coordinator II

Department: Utilization Management (UM)

Reports To: BCM Supervisor

Classification: Non-Exempt

Status: Full-Time (Regular), Remote/Hybrid

POSITION SUMMARY

The Care Coordinator II is responsible for serving in an advanced support capacity and for providing exceptional health care support services to the CHCN members, providers, and staff. The position provides research, trouble shooting and expert assistance for authorization requests, benefit verification, inpatient coordination, departmental programs and activities, and procedures and policies related to the role. The duties of this position include making telephone calls to members and providers as well as processing BCM referrals in a timely manner.

ESSENTIAL POSITION RESULTS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.

• Research medical utilization management requests using a variety of resources including the Health Plans’ evidence of coverage, CHCN policies and procedures, provider directory, industry healthcare resources and State eligibility verification systems.
• Act as the secondary liaison for Basic Case management/ interdepartmental relations.
• Refer cases to Case Managers for clinical review.
• Provide administrative and clerical support for utilization management and case management activities.
• Answer questions and resolves issues promptly from members and providers pertaining to referrals, benefit verification, eligibility verifications, function and authorization status and modification request.
• Create new BCM cases including CC (Care Coordination), TN (Transition into Network), CCS/TN (California Children’s Services Transition into Network), COC (Continuity of Care), EPSDT (Early and Periodic Screening, Diagnostic, and Treatment)
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in CHCN and the Health Plans’ policies and procedures relating to HIPAA compliance.
• Enter required data in a selected database program with accuracy in a timely manner.
• Consistently adhere to Health Plans/CHCN’s standards, policies, and regulations to meet Turn-Around-Time mandates for creating referrals as needed.
• Make telephone calls to members and providers according to Health Plans/CHCN’s Case Management protocols.
• Maintain detailed knowledge of all CHCN lines of business.
• Provide timely notification to BCM Supervisor of any and all issues affecting BCM compliance and/or CM member needs.
• Regular attendance and participation in required meetings
• Assist with New Hire Training/Implementation of necessary skills needed for a BCM Coordinator position.
• Perform other duties as assigned.
• Assist with clinic and health care center knowledge of pertinent needs of member.
• Assist with providing additional resources to CHCN members and supply these resources according to member’s needs.
• Assist with DME and appointment scheduling needs in relation to member requests.
• Increased knowledge of hospital-based procedures and knowledge of contracted hospitals within our network.
• CCS maintenance of records and member information as needed.
• Assist BCM and UM with updating the provider in-network availability list.
• Perform specific tasks within multiple workflows such as Medical Exemption Requests (MER). from the Health Plans and how to respond to these requests.
• Perform telephonic outreach to members as appropriate and document proper case documentation.
• Assist in the maintenance of the BCM letter library regarding automated letters such as COC, Case closure and Unable to Contact letters to members.
• Be well versed in the Health Plan websites in regards to member questions, needs and resources.

SUPERVISORY RESPONSIBILITIES

None

MINIMUM QUALIFICATIONS

Competencies

• Must foster a “Can-Do” attitude
• Detail-oriented with strong problem-solving abilities
• Excellent written and verbal communication skills, to allow for effective communication with all staff levels at CHCN
• Excellent attendance and consistent, pleasant demeanor
• Proficiency in CPT/HCPCS and ICD-10 codes, preferred.
• Proficient with all CHCN UM related database systems
• Self-motivated and self-managed person with the desire to learn and the ability to work well with others as a team
• Ability to prioritize and manage multiple projects and maintain deadlines at all levels.
• Knowledge and application of English grammar including composition, editing and proofreading skills.
• Strong organization skills, time management, multi-tasking capabilities and prioritization of work functions.
• Ability to handle detailed work, work with varying types of data and maintain confidentiality
• Ability to display a courteous, patient, and helpful attitude toward co-workers at CHCN organization
• Basic understanding of Health Plans/CHCN’s policies and procedures
• Assistance and basic understanding of medical terminology within CHCN CM environment and the ability to learn additional terminology as needed.
• Working broad knowledge of CM essential job functions.

Essential Requirements

• Two to Four years previous health care experience with medical records, medical billing, or medical office experience, preferred.
• Two to Three years of experience with State and Federal insurance programs, i.e. Medi-Cal, Medicare, IHSS, preferred.
• Associate or Bachelor’s degree in Social Sciences, Life Sciences, Business or a related field, preferred.
• Medical Assistant Certification or California Pharmacy Technician License or equivalent experience in a health care field with familiarity with medical terminology and concepts, preferred.
• Experience with Medi-Cal and/or Department of Health Care Services regulations and standards, preferred.
• Experience in an HMO/IPA or experience in a managed care setting a plus.
• High school diploma or General Education Degree (GED) required.

General CHCN roles:

• Foster an environment that promotes trust and cooperation among clients and staff.
• Enforce policies and procedures, including maintenance of client confidentiality, to ensure that the principles of CHCN are implemented.
• Be accountable for participating in decision making processes and understanding the outcome(s).
• Understand the values and principles of CHCN and applies them in work responsibilities.
• Participate in outreach activities, agency advocacy, and serves on ad hoc committees, as requested.
• Attend and participate all required CHCN meetings.

CERTIFICATES AND/OR LICENSES

None

PHYSICAL DEMANDS

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.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

WORKING CONDITIONS AND ENVIRONMENT

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.

While performing the duties of this job, the employee is regularly exposed to an inside environment.

The Community Health Center Network is an Equal Opportunity Employer.

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