CareMore Care Coordinator (ESRD)
WellPoint - Downey, CA

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The ESRD Program Care Coordinator is responsible for delivering and coordinating services for all ESRD members including but not limited to transplant related cases. The ESRD Program Care Coordinator works in collaboration with the ESRD Program Supervisor and lead clinician to ensure CareMore members receive proper care at dialysis facilities, outpatient nephrology clinics and hospital settings. The ESRD Program Care Coordinator, coordinates, monitors, and evaluates services to meet member’s health needs and to ensure appropriate use of clinical resources under the supervision of the ESRD Program Supervisor.

Essential Duties and Responsibilities

Essential duties and responsibilities include but are not limited to:

Monitors the delivery of care across all markets for the identification of quality of care issues related to ESRD and transplant cases (ie: delayed in care, post complications and family/member dissatisfaction).

Contact for assigned nephrology network for reporting of issues/concerns to ensure appropriate communication and management is executed (ie: Senior Medical Officer, Regional Medical Officer, Director of Case Management, Corporate Compliance/Risk Management and HIPPA Compliance Officer)

Coordinates and authorizes access placement as requested by nephrologists.

Gathers and reviews medical records for surgical referral with Senior Medical Officers.

Coordinates and communicates with nephrology office staff regarding initial access plan and dialysis center.

Based on industry standard metrics all CKD (Chronic Kidney Disease) are reviewed to ensure timely management of access for initial dialysis including, scheduling appointment with surgeon for pre-access evaluation as indicated.

On on-going basis keeps all providers involved in member’s care updated on appointments, condition change and need for additional clinical support.

Maintains access, admission and transplant history in CareMore’s database system.

Maintains and research all vascular surgery/procedures requests for all members as directed by Senior Medical Officer.

Requests and gathers necessary medical records as requested by Medical Director for all transplant candidates.

Provides on-going monitoring and coordination of care for all pre-transplant, transplant and post-transplant candidates; including tertiary care work up and resource management for member and family.

Observe all policies and procedures for use of time keeping system including attendance and tardiness.

Interact with patients, physicians, staff, and outside facilities in ways that demonstrate caring and reflect CareMore’s mission and philosophy.

Perform any additional / miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge / ability

Job Qualifications

Requires a high school diploma; 2 years of experience in Case Management Care Coordination in an HMO environment; or any combination of education and experience, which would provide an equivalent background. Medical Assistant Certification preferred.
Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).

  • Current WellPoint associates: All referrals must be submitted through the formal
associate referral process on WorkNet. Official guidelines for the associate referral
program can be found in My HR.

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WellPoint, Inc. (WellPoint) is a health benefits company serving 35 million medical members, as of December 31, 2008. The Company is an...