Care Management Coordinator II

Let’s do great things, together!

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Job Summary:
Provide support to the Healthcare Services Case Management team by assisting in the monitoring and review of all tiers of care coordination. Supports the Moda Clinical Care Team by assisting in member engagement through outreach campaigns, collecting member-specific health data, documenting member outreach/engagement, and data entry. The coordinator utilizes their clinical healthcare experience to navigate member needs and develop care plans directed towards improving member health outcomes. Completes reviews of annual and periodic health risk assessment surveys on members and provides reportable information to the supervisor for yearly reporting as appropriate. 

This is a FT WFH position.

 

Pay Range

$18.39 - $20.58 hourly (depending on experience). 
*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

Benefits :

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Primary Functions:

1. Initiates mailing campaigns to encourage case management engagement.
2. Research social determinants of health and equity needs that affect members and develop processes to enroll these members in case management services.
3. Reviews related referral and care plans monthly to meet compliance requirements.
4. Coordinate and initiate referrals to appropriate services and programs utilizing a large network of resources to assist member needs
5. Assists with triage of Health-Related Services funds requests
6. Collect information about a member’s social, clinical, and functional status to identify individual and case management needs.
7. Create, enter, and complete Health Risk Assessments and initiate appropriate care plans within the members health record.
8. Collaborate with RN Case Managers to initiate referrals, communicate specific member needs, and to assist in care planning.
9. Communicate effectively with other Medical Management support staff.
10. Analyze claims and encounters to identify high utilization members that would benefit from higher care coordination services.
11. Effectively uses the Moda Health systems to accurately determine eligibility, benefit plan, and physician networks associated with the member’s plan.
12. Utilizes the Moda Health systems for documentation of contact with providers and members.
13. Performs outreach calls to inform patients about care coordination services and start case workflows.
14. Ensure adherence of Health Insurance Portability and Accountability Act (HIPPA) and other regulatory guidelines including privacy and security.
15. Identifies member needs and research alternative solutions.
16. Completes other duties and special projects as assigned by the CM Supervisor and/or the HCS Manager.

 

Required Skills & Experience:

1. 2 - 4 years of experience in a medical office and/or case management experience required
2. Community/Traditional Health worker certification or Bachelor of Social Work (BSW) required
3. Proficient in Microsoft Office applications
4. Type a minimum of 35 wpm
5. Excellent written, verbal and interpersonal communication skills
6. Excellent organizational and detail orientation skills
7. Must present a professional business image in all settings
8. Ability to work well under pressure, work with frequent interruptions and shifting priorities
9. Strong problem-solving skills and critical thinking required
10. Ability to work independently, as well as part of a team, dealing with all levels of staff, members, providers, in a professional manner
11. Demonstrates professionalism, empathy, and discretion when working with patients, caregivers, and medical staff; adheres to HIPAA regulations.
12. High level of understanding of medical terminology, state and federal regulations and social determinates of health and equity
13. Knowledge of health plan benefits
14. Familiar with CMS (Medicare/Medicaid) rules and regulations

 

 

Together, we can be more. We can be better.
 
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. 

For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our View email address on j.brt.mv email.