Case Management Coordinator
Astiva Health
- Accurately enter confidential data into the case management system to ensure timely care coordination and outreach.
- Verify member benefits and eligibility upon receipt of care coordination or case management.
- Utilize DOFR or delegation agreements to drive decision making.
- Coordinate and assist with patient appointments, transportation or utilize community resources.
- Gather relevant information for the identified member population during assessment, care planning, interdisciplinary care team meetings, and transition of care.
- Complete applicable patient assessments in a timely manner.
- Coordinate with case manager to actively problem solve for patients.
- Proactively outreach to patients to verify that needs are being met and services are being satisfactorily delivered.
- Intervene at the client level to coordinate the delivery of direct services to clients and their families.
- Coordinate with primary can specialty providers to provide care to patients.
- Ensure all documentation and communication is complete and updated to partners at the IPA or MSO level and all clinical teams are updated to authorize patient services.
- Review all available community resources prior to requesting patient services for use and authorization.
- Serve as a resource for patients, providers, internal teams and external customers regarding plan policies, benefits, and care coordination.
- Support the Utilization Management department by uploading member admission, home health and skilled nursing facility admissions. Collaborate with department leadership to coordinate calendars for meetings and coordinate interdisciplinary team communications.
- Serve as the Outreach Liaison between the IPA/MSO's for all delegation reports and communications.
- Regular and consistent attendance
- Other duties as assigned
- High School diploma or GED required.
- Minimum of 2 years of experience working in the healthcare industry.
- Minimum of 1 year of prior experience working, training, or education within a healthcare environment.
- Strong working knowledge of prior authorization, case management principals, and regulations governing Medi-Cal, Medicare, and other government and commercial healthcare programs.
- Working knowledge or medical terminology.
- Excellent written and verbal communication skills with the ability to build and foster strong interpersonal relationships.
- Bilingual in a second language preferred.
Vacancy posted 1 day ago
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