Care Management Coordinator II
Administrative, HR, Business Professionals
Los Angeles, CA, US, 90017
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Care Management Coordinator II supports Nurse Specialists and/or Nurse Liaisons by handling the administrative functions of the care management/continuity of care/specialty liaison process including intake, logging, tracking and status follow-up.
This position collects information required by clinical staff to render decisions, provides assistance to management, Nurse Specialists or Nurse Liaisons in meeting regulatory requirements/time lines by maintaining an accurate database inventory of care management and continuity of care cases, and preparing monthly activity and/or compliance reports.
In addition, this position will perform data entry and processing of health risk assessments in the system, maintains confidentiality when communicating member information, and assists with the communication and coordination between programs. Prepares template determination/education letters for members and providers, with other duties as assigned.
Provides non-clinical support to the Nurse Specialists and/or Nurse Liaisons. This includes the technical aspects of the time sensitive processes for initiating cases, managing referral documentation, CCS referrals (if applicable), entering pre-certification/continued authorizations, identifying and responding to urgency of the request, appropriate documentation, case routing and tracking, routing of information, performing computer data input, faxing, filing of confidential member information, and maintaining logs of activity, etc. (45%)
Assists in the telephonic outreach calls to members identified during health risk assessments as in need of care coordination assistance. Consists of follow up calls to members to administer screening or obtaining clarification on initial responses. (20%)
Under the supervision of a care manager, assists with soliciting non-clinical information from PPGs and specialist concerning follow-up care related to care management. (15%)
Maintains the monthly reporting responsibilities for CCS, Continuity of care and care Management reporting such as CMO Report monthly to Dept. Director, quarterly reporting of CCS activity to MRMIB and CHP; ongoing referrals and authorizations for members in complex care management. (5%)
Accurately maintains an updated log of L.A. Care members identified as SPD or eligible with CCS cases. If members become ineligible with L.A Care or a specific program, members are referred to Member Services for transition to other applicable programs. Confirms members' eligibility by correspondence with different county CCS programs. (5%)
Performs other duties as assigned. (10%)
High School Diploma/or High School Equivalency Certificate
At least 1-2 years of coordinator experience in health care/health services, with at least 1 year of experience in Medi-Cal managed care authorization processes and/or as a Medical Assistant.
Knowledge of MHC computer system a plus.
Knowledge of medical terminology and ICD-10 and CPT codes.
Strong verbal and written communication skills.
Proficiency with Microsoft Word, Excel, and Access.
Excellent organizational, interpersonal and time management skills.
Must be detail-oriented and a team player.
Persuasion Skills: Must be able to interface with members, medical personnel, and other internal and external agencies and sometimes convince/persuade others to comply with L.A. Care requirements and provide information in a timely fashion.
Bilingual in one of L.A. Care Health Plan's threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.
Certified Medical Assistant (CMA)
L.A. Care offers a wide range of benefits including
+ Paid Time Off (PTO)
+ Tuition Reimbursement
+ Retirement Plans
+ Medical, Dental and Vision
+ Wellness Program
+ Volunteer Time Off (VTO)