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St. Joseph Health / Covenant Health Care Management Coordinator - Senior Service in Fullerton, California

We are looking for a Care Management Coordinator for the Senior Service Department at St. Jude Medical Center.

Location: Fullerton, CA

Work Schedule: Full time - 80 Biweekly hours

Shift: 8 hour, Days

Job Summary:

Under the direction of the Supervisor or Manager, this position is responsible for providing support to the Care Management team who coordinates care for identified members/patients throughout the healthcare continuum. This position works closely as a healthcare team member and performs clerical tasks related to the overall team functions and activities identified during the initial and ongoing assessment and management of members/patients.

Essential Functions:

  • Coordinates referrals based upon business rules, payor/government regulations, complexity of member/patient, care management admission.

  • Initiates telephone, fax or internet contacts with payors, post-acute and/or community resources. Determines availability of services specified. Facilitates transportation as necessary.

  • Assists team as directed to ensure comprehensive discharge planning throughout the healthcare continuum facilitating communication throughout all access points and all members of the healthcare team, including the health plans contacts, facility discharge planners/case managers, providers in network and out of network and other appropriate contacts.

  • Demonstrates excellent communication skills. Documents communication of information to and receipt of information from all members of the healthcare team, including payors and post-acute providers as required. Enters authorization number and pertinent data into the information system as assigned.

  • Provides secretarial and clerical duties for the Department.

  • Reviews reports to assist with identifying appropriate patients. Maintains work lists as appropriate.

  • Assist in determining of appropriate coverage including hospitalization, DME, out-pt. medications, etc., obtaining authorizations as needed. Enters all authorizations into IT systems as required.

  • Tasks Primary Care Provider (PCP) or other members of the healthcare team, as appropriate regarding member/patient regarding UM or CM concerns.

  • Phone or fax clinical review to payors or providers as directed and provides follow up to support avoidance of denials.

  • Participates as a team member and communicates effectively with the health care team.

  • Responds to calls for information from payers and follows up on existing payer request. Contacts appropriate care manager as required.

  • Participates in staff meetings and other interdisciplinary meetings.

Skills :

  • Knowledge of or ability to learn MCG Care Guidelines application, TouchWorks, IDX, Word, Excel, MEDITECH.

  • Knowledge of utilization management, case management and healthcare provided throughout the continuum.

  • Ability to handle multiple tasks at a time and remain organized.

  • Ability to work autonomously but also as a team member.

  • Ability to manage data and generate reports using current computer programs.

  • Ability to plan, organize, prioritize, work independently and meet deadlines.

  • Ability to work as a contributing member of an interdisciplinary team.

  • Preferred: Proficient in all Microsoft Office applications including Word and Excel.

Minimum Position Qualifications:

Education :

  • H.S. Diploma or GED

  • Coursework/Training - Completion of Medical Terminology coursework or working knowledge of Medical Terminology.

Experience : 1 year Healthcare experience.

Preferred Position Qualifications:

Education : Associate's Degree in Related field.

Experience :

  • Managed care or case management experience.

  • Experience with MCG Care Guidelines, TouchWorks, MEDITECH, Allscripts, Enterprise and/or IDX.

Licenses/Certifications: MA certificate

St. Jude Medical Center is a faith-based, non-profit, 384-bed, tertiary care facility, and is one of Southern California's most-respected and technologically-advanced hospitals. With nearly 700 of the area's finest physicians on staff, St. Jude offers nearly every medical specialty and sub-specialty. Whether for the birth of a baby, life-saving surgery or a routine mammogram, St. Jude continues to set the standard for medical care and offers the community the most comprehensive array of services and programs.St. Jude Medical Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Jude Medical Center complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Positions specified as “on call/per diem” refers to employment consisting of shifts scheduled on as “as needed basis” to fill in for staff vacancies.

Company: St. Jude Medical Center

Category: Community Services