Career Center

The Senior Case Management Coordinator provides support to the ambulatory case management processes and Ambulatory Nurse Case Managers. The coordinator reviews ACM referrals and patient information daily and enters and updates referrals into the Access Express system as per departmental policy. In addition, the Coordinator assists in identifying, tracking, and coordinating services for patients who fall under/qualify for the department's ambulatory and disease state management programs. These patient populations include medically and socially fragile patients, patients who inappropriately access services, and patients who have complicated medication regimens and need an additional supportive assistance.

Duties & Responsibilities:

• Reviews pertinent patient information and enters/updates inpatient, SNF, home health and DME referrals as needed.
• Ensures that appropriate documentation is uploaded as part of the electronic medical record (EMR).
• Responds to Health Plan inquiries regarding case management services and directs inquiries to appropriate care managers, as appropriate.
• Coordinates follow-up care and appointments with pts care team (PCP, Specialist, pharmacist, etc.)
• Prioritizes and processes, as per policy, referrals for target patient populations (i.e.: fragile seniors, catastrophic and transplant cases, frequent utilizer of ER and inpatient services), as well as patients diagnosed with specific diseases (i.e.: cancer, asthma, COPD, AIDS, etc.).
• Acts as a liaison, captures information and tracks all patients referred to the ACM program.
• Assists in coordinating care for specific high risk/high cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
• Documents all patient specific information in appropriate information systems.
• Assists in verifying health plan benefits and coordinating ambulatory services.
• Assists in training new members of the department in referral entry and eligibility verification, as well as other department policies and procedures.

Education:

High school diploma/GED required.

Experience:

Three (3) years of healthcare experience, a general knowledge of medical terminology and experience with community resources and social supports required.

Three (3) years of previous utilization management, medical assistant or managed care experience highly preferred. Experience with community resources and social supports; previous case management, utilization management, or discharge planning experience. Knowledgeable with HMO, Medicare, and MediCal/Medicaid guidelines.