Managed Care Organization Care Coordinator I

POSITION DESCRIPTION:

Responsible for coordinating follow-up visits and screening education for patients of all ages based on patient information provided by Managed Care Organizations (e.g. Sunshine Medicaid, Ambetter Marketplace, Simply Medicaid, etc.) using telephonic outreach as well as established email and text outreach campaigns. Works collaboratively with Level II MCO Care Coordinators to support submission of supplemental data to close various care gaps. Responsible for completion of hospital follow-up outreach to FHC patients using hospital discharge lists received from Lee Health and other contracted insurance plans. MCO Care Coordinators may also participate in other report analysis and patient contact projects, aimed at improving patient healthcare through increased contact and the scheduling of regular visits. Additionally, adheres to Corporate Compliance program, by reporting improper or unethical conduct, violation of applicable laws, regulations, or program requirements.

DETAILED DUTIES AND RESPONSIBILITIES:

• Apply knowledge of medical terminology and HIPAA regulations.
• Establish & maintain effective working relationships with colleagues, management & providers.
• Uses appropriate tone and language when speaking to patients on the phone to motivate them to complete follow up appointments and convey care to increase patient satisfaction with our center.
• Complete timely documentation of patient outreaches.
• Educate patients on different types of preventative screenings.
• Provide patients with applicable agency resources.
• Schedules evaluation appointments with providers for patients of all ages.
• Effectively and accurately uses Electronic Health Records (EHR) to document and track patient history.
• Maintains accurate and up-to-date records and standardized data on all patients.
• Refers patient to in-house services lines as needed.
• Assists with hospital follow up call outs to FHC patients based on external discharge lists received.
• Required to attend and contribute during team meetings and other training coordinated by manager.
• Willingness to work on other Healthcare Effectiveness Data and Information Set (HEDIS) pilot programs as assigned.
• Other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Strong interpersonal skills.
• Comfort with patient-centered approach that makes patients feel comfortable attending needed appointments.
• Ability and willingness to work in a time-limited, structured, and solution-focused environment.
• Ability and willingness to function independently and proactively in a primary health care setting.
• Ability to maintain a professional stance if conflicts arise with other staff.
• Flexibility to adapt to unforeseen needs or circumstances.
• Effective use of the Internet, Excel reports, and the EHR systems within the work environment.

TRAINING AND EXPERIENCE REQUIREMENTS:

• Minimum 2 years’ experience in primary care setting.
• Bilingual (Spanish/English) preferred.

SPECIAL REQUIREMENTS:

• Computer abilities: word processing, excel spreadsheet experience (including editing, filtering, and creating graphs and tables) and presentation software.