JOB SUMMARY:
Provides support to the carrier in coordination of workers' compensation patients until the case is closed by the carrier and/or discharged by the physician.
ESSENTIAL DUTIES & RESPONSIBILITIES:
- Manages the completion of any portion of process that Care Coordinator was unable to complete, if any.
- Facilitates flow of evaluation(s), orders, and progress notes from provider(s) to Nurse Case Manager or adjuster per One Call Care Management's nursing department protocol.
- Reviews MD orders, initial assessments/evaluations and progress notes on patient, and communicates with provider and carrier per One Call Care Management's Nursing department procedure to provide updates and ensure progress of patient.
- Locates provider(s) or contact established provider(s) to arrange additional service for current patient.
- Communicates with Nurse Case Manager/adjuster and/or provider to ensure appropriate physician orders are obtained and followed.
- Contacts Nurse Case Manager or Adjuster to obtain authorization for additional or continued service(s).
- Creates purchase order(s) per One Call Care Management's nursing department procedure to authorize additional or continuation of service(s) to provider.
- Utilizes appropriate tracking tools, i.e. authorization logs, Outlook Calendar or Task function, to ensure follow-up on critical timelines as outlined in One Call Care Management's nursing department procedures for obtaining evaluations/notes, tracking authorizations, and contacting carriers.
- Coordinates quality assurance issues or concerns involving patient care, retrieval of evaluations and/or notes, and authorization of services closely with assigned Quality Assurance nurse.
- Maintains thorough, up-to-date documentation on each patient in patient database.
- Closes file per One Call Care Management's nursing department procedure once Nurse Case Manager or adjuster cease authorization or physician discharges from home care.
- Notifies appropriate One Call Care Management's department(s) of referrals requiring their expertise.
- Assists in training new associates as requested by Nursing Department Training Leader.
- Performs special projects as assigned and prioritized by management.
EDUCATIONAL AND EXPERIENCE REQUIREMENTS:
- Registered Nursing degree; (R.N., L.P.N., or M.A.) with a minimum of two (2) years of experience in acute setting, home care, or front and back medical office.
ESSENTIAL KNOWLEDGE, SKILLS & ABILITIES:
- Knowledge of the company's products, services and business operations to enable resolution of customer inquiries.
- Excellent customer service skills that build high levels of customer satisfaction.
- Excellent verbal and written communication skills.
- Computer navigation and operation skills.
- Demonstrates effective people skills and sensitivities when dealing with others.
- Ability to work both independently and in a team environment.
- Ability to work in an environment that aligns with the company's diversity, equity, inclusion and belonging standards.
- Ability to work both independently and in a team environment.
- Demonstrate our core values of Think Big, Go Fast, Deliver Awe, and Win Together.
PHYSICAL/MENTAL DEMANDS & WORK ENVIRONMENT:
- This position will be performed in the colleague's home. Work-from-home requirements include the colleague's ability to set up computer equipment within their home office.
- This job is primarily sedentary and may involve repetitive motions; the colleague must be able to remain in a stationary position for extended periods of time, operate a computer and other office equipment, assess information and files stored electronically, and converse/exchange accurate information with others, simultaneously.
- The colleague must be able to discern text displayed on a monitor, input data into specific fields using a keyboard, and adjust focus to distances of up to three feet.
- The colleague must have the ability to learn new tasks, follow established processes, maintain focus, complete tasks independently, complete multiple tasks simultaneously, communicate professionally with colleagues and customers, and complete tasks in situations that have a speed or productivity requirement.
- The colleague must be able to manage moderate to significant mental stress as a result of, but not limited to, a dynamic and heavy workload.
Please be advised that job descriptions typically change over time as business needs, job requirements, and employee skill levels change. As such, One Call retains the right to change or assign other duties to this position at any time.
Clinical Care Coordinator I
Entry level role. Basic skills with moderate level of proficiency. Generally performs a high volume of basic inquiries about One Call Care Management's products and services by following standard scripts and procedures. Works under close supervision without latitude for independent judgment. Consults with senior peers and team leads on non-complex issues to learn through experience. Associates will handle one service line or more and will become knowledgeable in these areas before moving into a level II role.
