Jacksonville, Florida
Care Coordinator, Case Management Job Opening in Jacksonville, Florida - The Care Coordinator is responsible for UM/CM Coordinator functions as defined below:
General :
(May include but are not limited to)
Assist team with Daily census by entering Face sheets for hospitals and SNF?s
Obtain medical records from hospitals and SNF?s
Attach medical records to authorizations
Enter referral in system using ICD 9 and CPT coding
Monitor Fax Folders
Contact doctors? offices requesting additional records
Creates cases, tasks and completes assessments in Case Management module for all Hospital and SNF discharges.
Complies with tasks assigned by nurse and, as appropriate, documents accordingly.
Maintains a case load and contact High Risk members as assigned; follows protocol regarding frequency of contact.
Maintains documentation on members contacted.
Assists with COC?s
Reaches out to members telephonically and meets high risk members in clinic.
Establishes relationships with members, earns their trust and acts as patient advocate.
Notifies nurse If members appear to be non-compliant or there appears to be a change in condition
Assists with outreach activities to members in all levels of Case Management Programs.
Assists with maintaining and updating member?s records
Assists with mailing or faxing correspondence to PCP?s, Specialists, related to, as needed.
Assists with mailing correspondence to members, related to CCIP activities, as needed.
Requests medical records from PCP?s, Specialists, Hospitals, etc., related to members activities, as needed.
Performs mini-audits on CM records as directed by Supervisor
Maintains inventory of educational materials.
Attends Case Management presentations and participates, as appropriate.
Recognizes work-related problems and contributes to solutions.
Meets specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs).
Maintains confidentiality of information between and among health care professionals.
Other duties as assigned by CM Supervisor, Manager or Director of Healthcare Services.
Minimum Education and/or Experience:
High school diploma or general education degree (GED); with one to three months related experience and/or training; or equivalent combination of education and experience. No licensure required.
Knowledge of ICD9 and CPT codes
Experience working with IPAs
Knowledge of Managed Care Plans and medical terminology
Experience entering referrals and prior authorizations
Other:
Basic Computer Skills, 25 WPM (Microsoft Outlook, excel, word
Bilingual (English/Spanish) preferred
Medical Terminology Certificate preferred
Knowledge working in Access Express/Portal, epic, essett (not mandatory)
Good oral, written and telephone skills
Skills and Abilities:
Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Communicates effectively using good customer relations skills.
Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10?s and 100?s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Computer Skills: Basic skills required.
Other Skills and Abilities:
Good organizational skills
Ability to reason and carry out instructions.
Good interpersonal skills.
Read, write and speak English fluently.
File systematically.
FLSA Status: Non-Exempt
Job Type: Full-time
Job Type: Full-time
Required education:
High school or equivalent
Required experience:
Managed Care: 1 year
Telephone Skills: 1 year
Healthcare: 1 year
Customer Service: 1 year
Required language:
Spanish
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