Case Management Coordinator / Job Req 704970318

PRINCIPAL RESPONSIBILITIES:

Under direction from the Non-Clinical Supervisor of Case Management, the Coordinator of Case Management will support case management staff and health plan members for the purpose of non-clinical care coordination. The Coordinator of Case Management will use customer service skills to establish positive relationships with members over the phone, along with strong listening skills, excellent verbal and written communication skills, a clear speaking voice, and an understanding of Alameda Alliance for Health various case management programs, plan benefits and services. This role will focus on directly assisting members needing support in accessing Case Management, Community Supports and/or Enhanced Care Management (ECM) team members.

Principal responsibilities include:

• Assist staff in identifying and providing outreach, orientation, and basic care coordination services to members that may benefit from services.

• Establish and maintain effective, ongoing relationships by facilitating communication and coordination with participants, patients, and members, their caregivers, and PCPs/Providers as well as other identified resources to which the patient was referred, based on each member's continued needs.

• Participate in meetings and trainings with other departments to gain general knowledge of care coordination and specific physical and behavioral health conditions

• Provide guidance, support, education, coordination of care and other assistance to participants, members, and patients and/or their family members, as they move through the healthcare continuum.

• Provide telephonic, or email support to other Alliance departments, participants, patients, and members in the case and disease management programs to meet their treatment/care plan goals in coordination with case managers where appropriate.

• Demonstrate a comprehensive understanding of coverage and benefits in order to promote appropriate service utilization and increase participant, member, and patient knowledge and satisfaction.

• Recognize and resolve continuity of care issues or other problem areas promptly.

• Educate and answer inquiries from participants, patients, and members and/or their family members about benefits, services, eligibility and referrals with a positive and professional approach, promoting participant, patient, and member satisfaction and retention.

• Identify and provide appropriate community referrals for participants, patients, and members, facilitating access to appropriate support services, including medical and social resources to address presenting issues and assist in the removal of barriers.

• Collaborate in a positive interdisciplinary approach with other CM/DM staff, Medical Services, Provider Services, Member Services departments as well as community resources to ensure most appropriate level of care and optimal outcomes.

• Maintain security, confidentiality and integrity of electronic database.

• If appropriate, work with state and federal eligibility and enrollment staff/vendors to assist in continuity in enrollment.

• Research and compile data for special projects.

• Complete other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Complete and document all telephone calls to members and explain health plan program benefits to Alliance members. Describe the types of services the Alliance and other community partners offer.

• Receive inbound calls and make outbound calls.

• Accurately maintain member database to ensure data integrity.

• Copy, fax, and distribute documents through mail or in person.

• File maintainence, record keeping, and documentation of work products.

• Participate in departmental and non-departmental meetings and other initiatives.

• Perform writing, administration, data entry, analysis, and report preparation.

• Assist members in communicating and providing light coordination services with PCPs, specialists, hospitals, and other community providers.

• Comply with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.

• Constant sitting and working at desk.

• Constant data entry using keyboard and mouse.

• Constant use of a telephone head-set.

• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.

• Frequent lifting of folders, files, binders and other objects weighing between 0 and 30 lbs.

• Frequent walking and standing.

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Bachelor's degree in health care related area of study, or

Two years of college, with a minimum of two years' experience health care

• Have a cleared TB test prior to or within seven days of hire.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Minimum two years office experience in a medically related field (e.g., physician office, home health department, case management, social work).

• Minimum two years of direct customer service experience in the healthcare field, preferably in a health plan setting and a working knowledge of medical and insurance terminology; care delivery and coordination.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Proficiency in correct English usage, grammar, and punctuation.

• Fluency in English required.

• Experience in managed care organization or health plan a plus.

• Experience working with case and disease managers or programs a plus.

• Experience interacting with physicians, physician offices, hospital discharge coordinators and/or community-based programs preferred.

• Good analytical and interpretive skills.

• Strong organizational skills, proactive and detail-oriented.

• Sensitivity to a diverse, low income community.

• Excellent critical thinking and problem solving skills.

• Ability to act as resource.

• Excellent presentation, customer service and delivery skills.

• Effective communication style (written and verbal) with proven ability to positively influence behavior and arrive at a "win-win" resolution.

• Strong customer service background.

• Excellent active listening skills, interpersonal, and communication skills.

• Enjoy problem-solving with people with challenges.

• Ability to plan and execute projects independently.

• Ability to work in cooperation with others and to work in a multidisciplinary company.

• Ability to handle multiple projects and balance priorities.

• Ability to work on repetitive tasks.

• Ability to type 50 wpm.

• Knowledge of modern office methods and procedures, equipment and filing systems.

• Familiarity with Alameda County resources a plus.

• Proficient experience in Windows including Microsoft Office suite.

Employees who interact with members of the public may be required to be tested for Tuberculosis and fully vaccinated against COVID-19 and influenza. Successful candidates for those positions/ classifications may be required to submit proof of vaccination against influenza and/or COVID-19, a negative Tuberculosis test, or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates should not present proof of vaccination until instructed to do so by the Human Resources department.

SALARY RANGE $33.46-$50.20 HOURLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.