Care Management Coordinator

New England Quality Care Alliance (NEQCA) – Braintree, MA

GENERAL SUMMARY:Performs duties requiring both basic clinical and administrative support skills to assist the Care Management Department where assignments are confidential, complex and involve handling information of strategic importance. Must be able to work independently and to manage multiple tasks simultaneously. Contact with all levels of network personnel requires the use of considerable discretion, judgment, tact, and diplomacy. PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

  • Transitions of Care Coordination:
  • Reviews Admission/Discharge/Transfer (ADT) reports daily to identify patients discharged from hospitals with EHR access.
  • Pulls hospital discharge summaries, reviews to determine if appropriate for
  • Transitions Program according to established guidelines.
  • Creates care management referral event in Athena to designated care manager
  • Maintains ADT spreadsheets to track care management referrals.
  • Escalates cases to the Regional Care Manager for urgent care management follow-up.
  • Coordinates and assists with the patient identification process for care management by reviewing and distributing patient lists from multiple sources including but not limited to Informatics, Patient Ping, Admission/Discharge/Transfer (ADT) reports and referrals from practices as well as payors.
  • Scans and uploads clinical documentation into Population Health Management applications, including but not limited to Athena Health and Trucare.
  • SNF 3 Day Waiver:
  • Assists Local Care Organization (LCO) staff to verify patient eligibility as required.
  • Collect data from LCOs to fulfill 3 Day Waiver reportables to NEQCA and CMS.
  • Maintain calendar of 3 Day Waiver report dates and submit reportables at required intervals.
  • Serves as liaison between Care Management, HIS team and NEQCA practices to facilitate and track the remote EMR access and permission process.
  • Notifies the Tufts Medical Center Risk Management Office of new hires or terminations for Malpractice Insurance coverage for NEQCA licensed Care Management Staff.
  • Provides administrative support to the Behavioral Health team to assist with events/activities such as scheduling of meetings, creating presentations, mailing and tracking of patient and providers satisfaction surveys.
  • Maintains and updates Care Management LCO roles and assignments in Salesforce.
  • Maintains and updates Care Management orientation training manuals and schedules orientation for new Care Management Department hires.
  • Distributes and files daily/monthly payor reports including but not limited to DOA, Companion, Member level, Hospice, Institutional, Custom Care and LCO Utilization Review Packets.
  • Develops and produces a variety of reports, including but not limited to project plans, Athena Activity, Status and Referral Reports.
  • Establishes and maintains folders in the Shared Drive of extremely sensitive, confidential information, ensuring efficient retrieval.
  • Maintains a centralized calendar of report due dates and is responsible for setting up reminders to appropriate staff members in advance.
  • Participates in Care Management Department meetings as required. Maintains detailed records of meetings as deemed necessary by the department leadership.
  • Provides coverage for Care Management Data Specialist and Care Management Associates as required or directed.
  • Retrieves and tracks professional licensure renewals for staff from Web based licensing boards; tracks and reports out mandatory training and CEUs for all care management staff to payors.
  • Receives phone calls, messages, and electronic correspondence. Provides informed interpretation on NEQCA policies and procedures to internal and external customers and refers matters to appropriate members of the department.
  • Maintains collaborative team relationships with peers and colleagues in order to effectively contribute to the working group s achievement of goals and to help foster a positive work environment.
  • Maintains and orders patient education resources and brochures to ensure consistent inventory.
  • Typical applications software used: Word processing, Excel spreadsheets, PowerPoint presentation graphics, Salesforce, Access database, Smartsheet and Lucid chart.
  • Performs other similar and related duties as required or directed.
  • Knowledge of medical terminology and basic understanding of management of chronic health conditions and population management required.
  • Prior customer service experience preferred.
  • Very strong working knowledge and proficiency with technology and business software (Microsoft Office).
  • Detail oriented, with strong organizational skills and multi-tasking abilities.
  • Excellent interpersonal and communication skills telephonically, electronically as well as face to face.
  • Demonstrates, after receipt of training, use of all applicable electronic systems/applications including but not limited to the patient registry, Electronic Health Records (EHR), Smartsheet, Lucid Chart and population health management systems.
  • Typically requires a Medical Assistant Certification preferred and/or Associate s Degree in Health Science or equivalent.
  • Some college preferred in related areas such as health sciences, health care, customer services, administration etc.
  • 1-2 years experience as a Medical Assistant or equivalent.
  • An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.
  • Customer service, healthcare, administrative experience a plus.
  • Proficient in Word, Excel and Power Point.
  • Commit to completing comprehensive outreach education certification program courses (as defined by supervisor) within the first year of employment
  • Example of Courses:
  • Motivational Interviewing
  • Management of Chronic health conditions and population management
  • Health Literacy
  • Cultural Diversity
  • Navigating Health Insurance / Health Benefits
  • Outreach Education
  • Care Coordination & Team-Based Care
  • Effective Communication
  • WORKING CONDITIONS/PHYSICAL DEMANDS:Work is in a fast paced office-based setting. Reliable transportation is necessary. The NEQCA office is located in Braintree with travel to Local Care Organizations and community hospitals. Work often includes meetings outside of normal business hours AMERICANS WITH DISABILITIES STATEMENT:Must be able to perform all essential functions of this position with reasonable accommodation if disabled. The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. New England Quality Care Alliance reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

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