Care Management Service Coordinator, Senior Job Opening

Care Management Service Coordinator, Senior

Tufts Health Plan

• Watertown, Massachusetts
Category: Key Account Manager

We enjoy the important work we do every day on behalf of our members.

Job Summary

Under the direction of the Administrative Manager and in collaboration with the Clinical Manager, the Transition Coordinator is responsible for telephonically supporting member transition of care episodes pre-operatively, following hospital or ED services, as identified through predictive modeling, or as determined by department needs. The Transition Coordinator is a key member of the care management team who works independently to contact assigned members for telephonic outreach, screening and support with care coordination needs. The Transition Coordinator functions as a key customer service representative for the department representative for both internal and external customers. The Transition Coordinator is also responsible for timely triage and referral processes, tracking logs, key account support, and other administrative functions as determined by the department.

Job Description

Member Transition Support
Responsible for short term follow-up screenings with members discharged from post-acute hospital and emergency department settings, as well as members identified by other referral sources. Activities include, but are not limited to:
  • Independently assess members for the transition programs and gain solid understanding of their transition needs
  • Understand, support, and address member, family and/or caregiver needs and concerns, including unique and non-traditional life circumstances
  • Track and manage member needs within the defined intervention period for the member specific population, complete follow-up responsibilities within required timeframe
  • Appropriately recognize, communicate, and escalate identified issues to RN Care Manager or Clinical Manager for timely intervention/resolution
  • Under the direction of a Clinical Manager, provides education and coaching to the member, family, and/or caregiver about follow up care, and health insurance benefits which could also include mailing of letters and/or educational materials
  • Ensure timeliness in coordination of health care services. Assist members with scheduling appointments, tests, screenings, and transportation.
  • Follows up with the member’s Community Partner (CP) contact as need in order to ensure warm hand-off as needed.
  • Collaborate with RN Care Manager or Clinical Manager on external community services on transportation needs, as well as interface with external community agencies to schedule services or provide resource information to the member/care giver to support self-management
  • Assist in execution of special projects and outreach campaigns,
  • Understands and achieves the defined benchmarks and operational measures for Transition Coordinators to demonstrate proficiency in responsibilities which contribute to Department and company business goals
  • Supports the Clinical Transition team as needed to confirm discharge dates and close events timely, works as a liaison to UM Coordinator team, and attaches clinical documentation as applicable
  • Serves as essential liaison and link between members and care managers
  • Provides back-up coverage for administrative services staff based on needs of the department, including conducting outbound HEDIS follow-up
Department Administrative Support
  • Daily referral and triage tasks to meet the needs of CM department, with focus on ability to keep management team updated in a timely manner
  • Has solid working knowledge and provides daily updated information related to triage volume, capability based on caseloads, and referral follow-up requirements, including warm hand-off of member to a care manager
  • Compiles and tracks outcomes, makes recommendations for process improvement
  • Manages Referrals from the PC Mailbox, PC voicemail, and Right fax system
  • Support and maintain required department tracking logs and registry lists
  • Understand and perform key administrative functions for referral sources which may be related to attribution logs, daily admission reviews, and tracking of defined information
  • Solid understanding of key systems for appropriate documentation and dissemination of information (TAHP, Macess, CCMS, MedHOK, IBM connections platforms)
  • Interfaces with multiple internal departments and researches issues as needed to support management team and functions as liaison to staff, administration, internal and external stakeholders, including community organizations
  • Through relationship development, is able to familiarize and articulate benefits of CM transition program to internal and external customers and encourage referrals
  • Performs case documentation according to Department standard including but not limited to timely completion of daily tasks, timely opening and closing of transition of care cases, and same day case data entry.
  • Supports program reporting need with accurate documentation in identified trackers, and provides coverage associated with member triage and referral source management at the direction of the Clinical Manager.
  • Identifies, documents, and refers potential quality occurrences to the Clinical Manager for submission to Clinical Quality Improvement Department
  • Maintains compliance with Corporate Privacy and Communication Policy, standards for managing voice mail and will be available by phone during normal business to both internal and external customers

Requirements

EDUCATION:
  • B.A. B.S. LPN, or equivalent work experience, preferably in a health care setting or related field with business/computer background and skills preferred.

EXPERIENCE:
  • Minimum of 2 year experience in care management environment or its equivalent.
  • Wellness or disease management experience ideal
  • Proficiency in a second language is highly desirable
  • Medical terminology preferred
SKILL REQUIREMENTS:
  • Use of excellent customer service and interpersonal skills, both oral and written communication skills, to represent Tufts Health Plan to members and providers and form positive and collaborative relationships
  • Strong organizational skills with the ability to juggle multiple priorities and follow tasks to completion
  • Solid time management skills to support timely completion of welcome calls with screens for members discharged from acute settings
  • Capability to function independently and within a team environment
  • Ability to use judgment to identify issues and escalate accordingly to a supervisor and relevant Tufts Health Plan departments
  • Ability to problem solve, research, and work independently
  • Must be able to exercise sound judgment
  • Proficiency required in Microsoft Word and Excel
  • Proficiency with or ability to learn technology for initiating and participating in web based communications: webinars, instant messaging, slim client, soft phone or others
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS:
  • Fast paced office environment handling multiple demands independently
  • Position has opportunity for remote work as defined by the Administrative Manager
  • Must be able to work and communicate with internal and external customers in a telephonic office environment
  • When in office, cubicle based work environment with exposure to others voices and work sounds
  • Ability to enter data and type the information received during a telephone conversation
  • Ability to carry 5 – 25 pounds of materials from one business area to another, approximately a distance 100 yards
  • Digital and manual dexterity required for keyboard along with ability to work on a display monitor for long periods of time


CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!