The Care Coordinator Assistant is responsible for conducting member and provider outreach to ensure that members are receiving care and services needed. The Care Coordinator Assistant goal is to increase member and provider knowledge regarding Plan programs and procedures and identify internal and external quality improvement opportunities.
· Conducts daily review of hospital census; contact hospital admitting departments to ascertain discharge information and assist with discharge activities.
· Generates admission and discharge notification for distribution to providers (medical and behavioral health admissions).
· Conducts discharge follow up outreach activities with providers and members to facilitate follow up appointments.
· Performs provider outreach activities to obtain HIV verification documents, Case Management assessments, Case Management re-assessments and other pertinent documentation, as directed by Care Coordinators.
· Collaborates with hospital and UM staff to request clinical information required for utilization review.
· Conducts activities such as member and provider outreach calls, run utilization/claim reports to locate members who have not accessed care.
· Educates members and providers regarding Amida Care policies, benefits package, community programs, care coordination activities and Article 49 Utilization Review process.
· Communicates with all members of the healthcare team as guided by Care Coordinators to ensure that members are receiving services and care in accordance with established clinical guidelines and the Plans benefit package.
· Arranges transportation, escort, and appointments as directed by Care Coordinators.
· Documents all communication and outreach activities and outcomes in the appropriate clinical database.
· Files all pertinent clinical information (i.e. admission and discharge notifications, CM documentation, HIV verification) in member files.
· Participates in biweekly case conferences and departmental meeting to indentify barriers to care and assist with the development of interventions, as appropriate.
· Assists with clinical studies, audit preparations, and ad hoc projects as directed by Care Coordinators and/or Director of Care Coordination and Utilization Management.
· Ensures member confidentiality and adheres to Confidentiality and HIPPA policies and regulations.
· Performs other duties as assigned by the Care Coordinators, Director of Care Coordination and Utilization Management and Medical Director.
High School Diploma or GED
EXPERIENCES AND/OR SKILLS REQUIRED
· Minimum of two (2) years of prior health care or managed care experience, preferred.
· Demonstrated knowledge of HIV community resources and HIV standards of practice.
· Knowledge of Article 49- Utilization Review process.
· Demonstrated strong verbal and written communication skills.
· Strong customer service skills required.
· Demonstrated strong organizational, analytical and interpersonal skills with detail-oriented focus required.
· Demonstrated computer proficiency, including but not limited to, Microsoft Office (Word, Excel, Access).
· Bilingual, Spanish preferred.
Amida Care's mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and...