Position Summary
The Health Coordinator – Case Management (CM) position provides administrative support to and acts as a member advocate on all clinical initiatives delivered by the Health and Quality division. Through these interactions with members, their caregivers, and their providers, the Health Coordinators will assist in the closure of care gaps, all aspects of care coordination, and advocating for members and providers to increase their satisfaction with the plan.
Essential Duties and Responsibilities
- Outreach via phone and mail to ensure the Health Risk Assessment (HRA) is completed by members
- Collect/reconcile medications and assist with/escalate any barriers identified for medication adherence
- Help decrease re-hospitalizations by reaching out to members to ensure their follow-up primary care provider visit is scheduled, discharge medications/medications at home were reconciled by a healthcare professional, and all other discharge issues/concerns are addressed
- Identify barriers to care and assist member with overcoming/resolving these barriers
- Assist members with locating and connecting with community resources
- Handle and resolve care coordination escalations received from other departments and vendors
- Collaborate with other care team members such as primary care provider, specialists, pharmacists, case managers, medical director, etc
- Request medical records for various quality and case management initiatives
- Support STAR ratings including member experience and HEDIS gap closure outreach
- Conduct research in multiple systems to locate additional contact information for hard to reach members
- Deliver administrative support to various department(s)
- Perform any other job-related instructions, as requested
Education, Experience and Qualifications
- Bachelor’s degree preferred.
- At least two (2) years of supporting a clinical function within a health plan or healthcare setting.
- A working knowledge of Medicare program requirements.
Knowledge, Skills and Abilities
- Excellent communication skills, including writing, critical-thinking, and the ability to work with others in a collaborative fashion.
- Working knowledge of health insurance and activities supporting members.
Physical Requirements
Computer Skills
- Outstanding computer skills (demonstrated use of Microsoft products, including Outlook, Excel, Word, and latest web-browsers) and overall computer use literacy.
Affirmative Action/EEO statement
The Company provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Other duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Exhibit A
Checklist: Job Analysis/Job Description Physical Activities
Physical Activities
Ascending or descending ladders, stairs, scaffolding, ramps, poles and the like.
☒ Never ☐ Occasionally ☐ Constantly
Moving self in different positions to accomplish tasks in various environments including tight and confined spaces.
☒ Never ☐ Occasionally ☐ Constantly
Remaining in a stationary position, often standing or sitting for prolonged periods.☐Never ☐Occasionally ☒ Constantly
Moving about to accomplish tasks or moving from one worksite to another.☒ Never ☐ Occasionally ☐ Constantly
Adjusting or moving objects up to 15 pounds in all directions.☐ Never ☒ Occasionally ☐ Constantly
Communicating with others to exchange information.☐ Never ☐ Occasionally ☒ Constantly
Repeating motions that may include the wrists, hands and/or fingers.☐ Never ☐ Occasionally ☒ Constantly
Operating machinery and/or power tools.☒ Never ☐ Occasionally ☐ Constantly
Operating motor vehicles or heavy equipment.☒ Never ☐ Occasionally ☐ Constantly
Assessing the accuracy, neatness and thoroughness of the work assigned.☐ Never ☐ Occasionally ☒ Constantly
Environmental Conditions
Low temperatures.☒ Never ☐ Occasionally ☐ Constantly
High temperatures.☒ Never ☐ Occasionally ☐ Constantly
Outdoor elements such as precipitation and wind.☒ Never ☐ Occasionally ☐ Constantly
Noisy environments.☐ Never ☒ Occasionally ☐ Constantly
Hazardous conditions.☒ Never ☐ Occasionally ☐ Constantly
Poor ventilation.
☒ Never ☐ Occasionally ☐ Constantly
Small and/or enclosed spaces.☒ Never ☐ Occasionally ☐ Constantly
No adverse environmental conditions expected.
☒ Never ☐ Occasionally ☐ Constantly
Physical Demands
Sedentary work that primarily involves sitting/standing.
☐ Never ☐ Occasionally ☒ Constantly
Light work that includes moving objects up to 20 pounds.
☐ Never ☒ Occasionally ☐ Constantly
Medium work that includes moving objects up to 50 pounds.
☒ Never ☐ Occasionally ☐ Constantly
Heavy work that includes moving objects up to 100 pounds or more.
☒ Never ☐ Occasionally ☐ Constantly
Job Type: Full-time
Pay: $40,000.00 - $65,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Education:
- High school or equivalent (Preferred)
Work Location: Hybrid remote in Owings Mills, MD 21117
