Case Management - BA

Duties:
Accountable to prepare, organize, and assist Case Managers.
Coordinate and maintain all office management functions, independently manage patient discharge functions such as transportation and nursing home
Under the direction of the LTSS manager and Care Manager, the LTSS Coordinator is a member of a team that provides support to our Medicaid members receiving Long Term Services. As an integral team member, the LTSS Coordinator will conduct monthly calls and work in conjunction with the Care Manager to ensure the member receives appropriate and necessary services, ensuring members are connected to care, engage with the member and the members care team to improve their health and community resources that will support their well-being to ensure quality outcomes (i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction, closing and reducing Gaps in Care) and cost effectiveness. The LTSS Coordinator will also support the Manager with assignments, reports, referrals, and electronic notifications.

Conducts monthly calls to all members assigned and ensures compliance with HIPAA verification
Utilizes the LTSS monthly assessment and other SDOH assessments when speaking with the member
Employ critical thinking and judgment when dealing with unplanned issues and escalates clinical issues to the members designated care managers
Accurately and timely documents member call interaction in the care management system, Disease Care Management System (DCMS) other applicable software programs are in compliance with professional standards and regulatory guidelines.
Ensure members have appointments with their providers.
Fulfills basic care coordination tasks for the member such as appointments, transportation, medication issues such as needing prescription or refill, DME, etc.
Conducts other supportive activities as assigned
Problem-solve members issues in an independent, resourceful manner
Perform non-clinical activities for members of varying age, clinical scenario, culture, financial means, social support, and motivation
Engage members/caregivers in a collaborative relationship, empowering them to manage their physical, psychosocial, and environmental health to improve and maintain lifelong well being
Promote communication, both internally and externally to enhance effectiveness of clinical and nonclinical services and overall case management services
Maintain accurate and complete documentation of required information in compliance with risk management, regulatory and accreditation requirements
Protect the confidentiality of member information and adheres to all company policies regarding confidentiality
Collect and prepare data, statistics, proposals and reports relevant to responsibilities as a LTSS Coordinator
Provides care coordination that reduces avoidable utilization, increases member satisfaction and retention, and reduces gaps in care
Assists all MetroPlusHealth departments with resolution of related member retention, utilization management, quality management, customer service, and provider relations concerns.

Skills:
Accountable to prepare, organize, and assist Case Managers. Coordinate and maintain all office management functions, independently manage patient discharge functions such as transportation and nursing home returns, intervene with insurance companies on utilization review activity.
A minimum of 4 years of experience in a healthcare-related field is required. Managed Care, care management/coordination, health education, health home or community-based experience is preferred.
Proficiency with computers navigating in multiple systems and web-based applications including Excel

Education:
One year experience
Associates degree required. Bachelors degree preferred from an accredited college or university in a healthcare related field.

Languages:
English

Schedule Notes:
Work Schedule: Full time Hours Per Week: 35 Days: Monday, Tuesday, Wednesday, Thursday, Friday Shift time: 9am - 5pm Work location: Hybrid Patient Facing: No Minimum education level: College Language competencies: English License/Registration required: No