Care Coordinator

• Oversee operational aspects of the Utilization Management team’s activities
• Identify opportunities to streamline and optimize utilization management workflows
• Improve efficiency and reduce administrative burden
• Collaborate and communicate with internal departments, external partners, and vendors
• Navigate efficiently between multiple electronic platforms
• Meet standard performance and quality metrics
• Perform other duties as required and assigned
• Interact with UM physician reviewers, external payer partners, and vendors
• Report to and work alongside the Manager of Operations, Utilization Management

Care Coordinator, Utilization Management

• Support administrative care management activities for LTSS Waiver members
• Perform outreach to members by phone
• Answer inbound calls and serve as a frontline support contact for members and providers
• Schedule services and support care plan next steps
• Connect members with health plan and community resources
• Explain care plan procedures and protocols
• Support member onboarding and send welcome letters, correspondence, and educational materials
• Document and maintain non-clinical member records
• Provide records to providers as needed
• Make referrals addressing Social Determinants of Health needs
• Perform other duties as assigned
• Comply with all policies and standards

LTSS Care Management Support Coordinator II

• Support the senior care management team and assigned member teams to ensure provider and partner services are delivered and continuity of care/member satisfaction is achieved
• Serve as a liaison alongside care managers and providers to coordinate member care
• Conduct member outreach by telephone and home visits
• Discuss care plans/service plans, next steps, resources, questions, concerns, and ongoing education with members
• Coordinate care activities with healthcare and community providers, partners, members, and caregivers
• Support member and provider inquiries, requests, and concerns related to care plans/service plans
• Develop knowledge of care management services and respond to complex or escalated issues
• Communicate with care managers, practitioners, and others to facilitate member services and continuity of care
• Perform service assessments/screening for members with complex needs and document care needs
• Maintain member records in accordance with state and regulatory requirements and distribute them to providers as needed
• Assist the care management team with triaging, adjusting, and escalating complex requests
• Follow contractual, regulatory, and organizational standards and policies
• Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers
• Provide education on available benefits and resources
• May assist with training and development needs
• Perform other duties as assigned

Care Coordinator III

• Support the senior care management team and teams assigned to members
• Coordinate care to ensure services are delivered and continuity of care/member satisfaction is achieved
• Serve as a liaison among care managers, healthcare providers, community providers, partners, members, and caregivers
• Conduct member outreach by phone or home visits
• Discuss care plans/service plans, next steps, resources, questions, concerns, and ongoing education
• Coordinate care activities based on care/service plans and accommodate changes or progress
• Respond to member and provider inquiries, requests, and concerns
• Develop knowledge of care management services and respond to complex or escalated issues
• Communicate with care managers, practitioners, and others to facilitate member services
• Perform service assessments/screening for members with complex needs and document care needs
• Document and maintain member records in accordance with state and regulatory requirements
• Triage, adjust, and escalate complex requests to management
• Follow contractual, regulatory, and organizational standards and policies
• Provide education on benefits and available resources
• Assist with training and development needs
• Perform other duties as assigned

• Support the senior care management team and teams assigned to members
• Ensure healthcare providers and partners deliver services and continuity of care/member satisfaction is achieved
• Serve as a liaison with care managers and providers to coordinate member care
• Conduct member outreach by phone and home visits
• Discuss care plans/service plans, next steps, resources, questions, concerns, and ongoing education with members
• Coordinate care activities with healthcare and community providers, partners, members, and caregivers
• Respond to member and provider inquiries, requests, and concerns
• Develop knowledge of care management services and respond to complex or escalated issues
• Communicate with care managers, practitioners, and others to facilitate member services
• Perform service assessments/screening for members with complex needs and document care needs
• Maintain member records in accordance with state and regulatory requirements and distribute records to providers as needed
• Triage, adjust, and escalate complex requests to management
• Follow contractual, regulatory, and organizational standards and policies
• Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers
• Provide education on benefits and available resources
• Assist with training and development needs as needed
• Perform other duties as assigned