Managed Care Coordinator coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Being a Managed Care Coordinator communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Additionally, Managed Care Coordinator typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). The Managed Care Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. To be a Managed Care Coordinator typically requires 5-7 years of related experience. (Copyright 2024 Salary.com)
DEPARTMENT: Care Coordination
REPORTS TO: Care Coordination Manager
SUPERVISION GIVEN: no
LOCATION: St. Helena, CA
HOURS: Mon to Fri, 40 hours a week
PAY RANGE: $24.39 to $33.14
About CommuniCare OLE
Established in 2023, CommuniCare OLE is the result of a union of two health centers with a deep roots in their respective communities and reputations for providing high-quality primary care to all, regardless of insurance or ability to pay: OLE Health of Napa and Solano Counties and CommuniCare Health Centers of Yolo County. Building on a legacy established by both organizations in 1972, CommuniCare OLE is a network of federally-qualified health centers with 17 sites across Napa, Solano, and Yolo Counties. It offers comprehensive care, including medical, dental, behavioral health and substance use treatment, nutrition, optometry, pharmacy, care coordination, referrals, and enrollment assistance to more than 70,000 individuals, and no one is turned away due to lack of insurance, immigration status, or ability to pay. Many services are offered outside of its sites, including mobile health, home visiting, and community and school-based programs.
JOB SUMMARY: The Care Coordinator is a member of the CommuniCare OLE clinical care team and works in continuous partnership with the patient, their family when appropriate, CommuniCare OLE care team, and relevant community partners to improve health outcomes and meet the patient’s desired health and wellness goals by:
KNOWLEDGE OF WORK
Knowledge of Organizational Improvement Methods |
Knowledge care coordination best practices |
Knowledge of Federally Qualified Health Centers and the key health center principles and guidelines |
DUTIES AND RESPONSIBILITIES
Evaluates social determinants of health, identifies barriers to care and addresses/resolves obstacles impeding progress
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Processes and closes the loop for community resource referrals
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Provides warm hand-offs for urgent and stat medical referrals and collaborates with referral coordinators to ensure medical referrals are processed
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Works with direct supervisor and QI department to ensure quality improvement initiatives are met |
Meets with each new patient and orients patient and family/caregiver(s) to CommuniCare OLE
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As a member of the care team, participates in huddles, team meetings, and case conferencing as needed
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Educates patient and family/caregiver(s) about relevant community resources
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Coordinates warm hand-offs for integrated care providers
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Provides support to primary care providers by completing forms and other tasks as needed
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Provides care management and creates care plans for patients on high-risk registry.
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Documents timely and efficiently in the EMR |
Attends appropriate training courses/webinars and meetings |
Gathers and reports data related to aspects of care coordination when needed |
Provides feedback for the improvement of Care Coordination processes |
Perform other duties as assigned |
EDUCATION, EXPERIENCE, TRAINING
BENEFITS
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