High Risk Coordinator

High Risk Care Coordinator

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources. HCP's vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP's mission of serving our members by facilitating the delivery of quality care.

Position Summary: The High Risk Care Coordinator facilitates the coordination and delivery of high quality patient centered care for a designated population of high risk patients under the guidance and supervision of licensed clinical staff. This role supports care management, transitions of care, utilization management, and patient engagement activities to improve clinical outcomes, enhance patient satisfaction, and reduce avoidable utilization. The High Risk Care Coordinator serves as a key liaison between patients, families, providers, hospitals, community resources, and internal clinical teams to ensure timely access to services and continuity of care across the healthcare continuum.

Essential Position Functions/Responsibilities:

• Contacts patients, physicians, caregivers, and family members on a daily basis for screening, intervention, education, and follow up as directed by the High Risk Clinical Team.
• Identifies potential transition of care needs including hospital admission, discharge, emergency department utilization, and post acute care requirements.
• Conducts outreach to high risk patients to support care plan adherence, medication compliance, appointment scheduling, and barrier resolution.
• Assists patients in navigating the healthcare system and accessing appropriate levels of care.
• Provides culturally competent, patient centered communication and customer service at all times.
• Collaborates with inpatient and outpatient clinical and administrative staff daily to identify patients requiring high risk intervention and follow up.
• Participates in daily interdisciplinary rounds with Medical Director, care management, case management, and clinical teams as appropriate.
• Reviews case notes and care plans with High Risk Clinical Team and documents interventions in designated clinical platforms.
• Communicates changes in patient status, barriers to care, and risk factors to appropriate clinical staff in a timely manner.
• Coordinates transitions of care including hospital discharge follow up, post acute placement, home health, and specialty services.
• Interfaces with providers, community agencies, home care agencies, skilled nursing facilities, and DME vendors as needed.
• Assists with scheduling follow up appointments, diagnostic testing, and specialty referrals.
• Supports medication reconciliation and adherence initiatives in collaboration with licensed clinical staff.
• Processes prior authorization requests, approvals, and denials for high risk patients following established protocols and turnaround times.
• Tracks authorization status and communicates updates to providers, patients, and internal teams.
• Maintains accurate documentation and timely updates in care management systems.
• Utilizes internal and external resources to identify gaps in care and support quality and utilization management initiatives.
• Supports management of high risk populations including patients with chronic and complex conditions such as congestive heart failure, diabetes, cancer, asthma, and COPD.
• Plans, prioritizes, and manages a high volume workload while meeting productivity and quality expectations.
• Participates in special projects, process improvement initiatives, and departmental activities as assigned.

Qualification Requirements: Skills, Knowledge, Abilities

• Excellent customer service, interpersonal, and communication skills
• Strong organizational and time management skills with attention to detail
• Ability to manage multiple priorities and meet deadlines in a fast paced environment
• Ability to work independently and as part of a multidisciplinary team
• Knowledge of care coordination, transitions of care, and managed care principles
• Knowledge of health plan benefits and prior authorization processes
• Strong problem solving and critical thinking skills
• Demonstrated proficiency in Microsoft Office (Word, Excel, Outlook, Teams)
• Knowledge of electronic medical records (EMR) and care management platforms preferred
• Keyboarding skills of at least 40 words per minute with accuracy

Training/Education:

• High School Diploma or equivalent required
• Associate Degree in healthcare, business, or related field preferred
• Care Coordination, Medical Assistant, or Healthcare Administration training preferred

Experience:

• 24 years of Managed Care, Care Coordination, Case Management, or related healthcare experience required
• Experience working with high risk or complex patient populations preferred
• Knowledge of health plan benefits and utilization management processes preferred
• Experience with prior authorization and referral management preferred
• Experience working in value based care or population health environment preferred

Base Compensation: $45,000 - $60,000 (21.63 - $28.44 per hour) Bonus Incentive: Eligibility based off organizational performance Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.) Equal Employment Opportunity Statement: HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Job Disclaimer: The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.