Care Coordinator

Overview Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. Job Summary The Care Management Care Coordinator functions as an integral part of the Care Management department. They are a member of a team that supports the day-to-day functions of a complex medical network. Activities include outreach, assignment of care management cases, mailbox communication and referrals, and other related duties. This individual must be able to plan, organize, and prioritize work to ensure completion in a timely manner and serves as a key contact and department representative to internal and external customers of the care management department through verbal and written communications. Key Responsibilities / Duties Support the General Case Management Process within the Case Management Department Initiates outreach cycle and documents in electronic record and/or member referral status. Identifies when to escalate issues that may prevent meeting department timelines for completion of notification to providers for denials and requests for information. Tracks, manages, and triages member needs within the defined intervention period for the member-specific population; completes follow-up within required timeframes. Provides education and coaching to the member, family, and/or caregiver about follow-up care, goals of transition care, and health insurance benefits to aid informed decisions and promote self-management of care. Ensures timeliness in coordination of health care services; assists members with scheduling appointments, tests, screenings, and transportation. Assists execution of special projects and outreach campaigns. Communicates with outside stakeholders and vendors to coordinate member care as needed. Performs general office duties Accurately enters data into MedHok, Casetrakker, and/or Jiva, and other databases and tracking programs. Completes clerical and Right Fax tasks as required. Effectively prioritizes tasks and ensures deadlines are met. Employs multi-tasking skills when multiple deliverables are due. Identifies issues to escalate to a Team Leader when appropriate. Support Clinical Initiatives and Programs Supports development and implementation of programs related to quality measures. Participates in outbound calling programs to members with potential quality triggers. Provides departmental process support in duties unique to assigned service operations area. Attends scheduled meetings and assigned training sessions. Other projects and duties as assigned. Qualifications – What You Need To Perform The Job Education Required (minimum): High School degree. Preferred: Associate’s degree in business and/or related administrative or clinical field is highly desirable. Experience Required (minimum): 3-5 years’ experience in a professional environment. Preferred: Experience in a health care environment, especially in managed care is highly desirable. Internal applicants: experience in Casetrakker, JIVA or the MedHok platform. External applicants must demonstrate potential to become proficient within 3 months of training. Skill Requirements Strong knowledge of Clinical Services’ departments and Point32Health organizations to assess situations and direct internal and external customers accurately and quickly. Strong computer skills in Microsoft Word, Excel, and email; familiarity with PowerPoint, Access, Visio, and other software desirable. Ability to work independently and as part of a team across multiple levels. Commitment to excellence in customer service; well-developed written and verbal communication skills. Ability to identify emergency situations and follow established protocol. Ability to handle multiple demands and priorities within set protocols and procedures. Strong organizational skills to manage workload and multiple tasks while maintaining customer service. Flexibility to meet department deadlines and cover responsibilities as needed. Sound judgment in telephonic and remote work environments. Working Conditions and Additional Requirements Must be able to work under normal office conditions and from home as required. Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. May be required to work additional hours beyond the standard schedule. Fast-paced office environment handling multiple demands independently. Cubicle-based hoteling and remote work environment with potential distractions. Ability to enter data and type information received during a telephone conversation. Ability to carry 5–25 pounds of materials a distance of ~100 yards. Digital and manual dexterity for extended computer use. Disclaimer The above statements describe the general nature and level of work and are not exhaustive. Management may change duties at any time. Salary Range $23.47 - $35.21 Compensation & Total Rewards Overview The annual base salary range represents salaries for this role and similar roles across the organization. Actual salary will be determined by factors including scope, skills, education, credentials, experience, and internal equity. Colleagues are eligible for variable pay as part of our total rewards program. Eligibility for bonuses, commissions, benefits, or other forms of compensation remains at the Company’s discretion. Point32Health offers a comprehensive total rewards package currently including: Medical, dental, and vision coverage Retirement plans Paid time off Employer-paid life and disability insurance with additional buy-up options Tuition program Well-being benefits Full suite of benefits to support career development, individual & family health, and financial health For more details on our total rewards programs, visit Equal Opportunity All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have concerns about a posting or recruiting contact, you may contact View email address on click.appcast.io #J-18808-Ljbffr Point32Health