Senior Health Care Coordinator

Job TitleSpearheads the work assignments and specializes as a subject matter expert for all other HCC Coordinators in all regions.QualificationsEducation Required: • Associate's degree in Healthcare, Nursing, or a related area; OR equivalent combination of education, training, and experience. Experience Required: • 3 years of office experience, specifically in either a high volume data entry office, customer service call center, or health care office administration department. • 1 year experience as a Telephonic Specialist. Preferred/Desirable: • Knowledge and experience in healthcare delivery to chronically ill patients preferred. • Experience with FACETS or other healthcare database. • Experience with Health Plan Utilization / Claims departments. • Prior customer service experience. • Bilingual skills, fluency in Spanish preferred. Certification or Conditions of Employment: • Pre-Employment background check. Competencies, Skills, and Attributes: • Bi-lingual preferred. • Strong customer service skills and diplomacy skills. • Strong listening, interviewing, interpersonal, written, and verbal communication skills; the ability to interact and work successfully with internal and external colleagues. • Ability to effectively prioritize and manage multiple tasks in a fast-paced environment. • Extensive knowledge of community resources and family advocacy resources and trends essential. • Competency with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications. Working Conditions and Physical Effort: • Regular and reliable attendance is an essential function of the position. • Ability to work OT if required. • Fast paced office environment. • Work is normally performed in a typical interior/office work environment. • No or very limited physical effort required. No or very limited exposure to physical risk.Job SummaryDevelops workflow processes through team participation and coordinates all program process changes by facilitating the production of team workflows. Develops and delivers training to all coordinators as necessary when process changes occur or new programs are launched in HCC. Provides telephonic community outreach resources and support to member and regional network providers. Facilitates, coordinates and advocates for Care Coordinator partners to ensure that processes are followed which allow for the delivery of services that enhance healthcare access and delivery by assisting in the coordination of safety net services that provide for basic needs such as education, housing, healthcare, legal, transportation and counseling assistance. Mentors other Care Coordinators and provides training for all newly hired Coordinators. Participates on multiple OCA development teams which look to incorporate MassHealth requirements while preserving the intent of care or disease management services to promote cost effective and quality healthcare delivery. Partners with Nurse Care clinicians on a daily basis to resolve any disparities in potential program flow. Maintains current knowledge of community resources for referral and linkage to member's needs.Key Functions/Responsibilities• Serves as subject matter expert. • Develops and delivers training and orientation of new hires. • Provides mentoring and guidance to Care Coordinators and Nurse Care Clinicians in relation to key functions of HCC care delivery. • Assists director/supervisor in auditing for compliance with workflows, policies, and documentation guidelines. • Identifies, in collaboration with the Nurse Care clinicians and non-clinicians, those members requiring access to and coordination of care. • Implements telephonic outreach strategies to engage members in Health Care Coordination using Motivational Interviewing techniques which increases the likelihood that Members join Care Coordination. • Provides educational materials to members with the goal of increasing Member knowledge and participation in their own healthcare management. • Triages cases into care management and provides referrals for RC upgrade when appropriate. • Collaborates with Nurse Care Clinicians to develop an Individual Care Plan and intervention strategies for each member referral and documents appropriately. • Maintains accurate and timely documentation. • Provides member coaching and education on how to access community resources and assists them in removing barriers to service access; outreaches and coordinates with providers when necessary. • Tracks and maintains progress records utilizing system software. • Maintains current knowledge and documents community resources for referral and linkage to assist meeting member referral or advocacy needs. • Participates in ensuring success of quality initiatives and provider network performance. • Learns and applies quantitative and qualitative measurement specifications; Enters, monitors and maintains HCC matrices, validates and monitors metrics. Coordinates as needed to ensure that Mass Health, HEDIS and NCQA quality goals are met. • Conducts activities related to Behavioral Health interventions such as the assessing and distributing of Behavioral Health referrals. • Independently discovers flaws in workflow processes and contributes to the reconfiguring of such processes. • Participates in Team Rounding session with MD's and Behavioral Health staff. • Contributes to other areas of the Business as a Subject Matter Expert. • Complies with established department matrices for performance and adheres to documentation standards developed by the Health Care Coordination team. • Regular and reliable attendance is an essential function of the position. Other duties as needed.