Remote Care Coordinator, Chronic Kidney Disease (CKD)

Overview of the Role:

Alignment Health is seeking an organized, detail oriented, and compassionate remote care coordinator, chronic kidney disease (CKD) to join the Care Anywhere team. As a care coordinator, you are responsible for UM / CM Coordinator functions as defined below. If you have experience as a front office medical assistant, want to be part of a growing organization, are hungry to learn and grow, and make a positive impact in the lives of seniors – we’re looking for you!

Schedule:

• Mon-Fri, Forty (40) hours per week
• 8:00am-5:00pm Pacific Time (1-hour lunch)
• 8:00am-4:30pm Pacific Time (30-minute lunch)

Responsibilities:

• Conduct calls to nephrology clinics, primary care physician (PCP) offices, and dialysis facilities. (75% of the position is making calls, and asking hard questions regarding treatment, comfortable with speaking with Physicians)
• Able to research and update labs from Quest, hospital notes, or other sources for accurate CKD stage.
• Review daily census for new admissions
• Obtain medical records from provider offices, hospitals, and skilled nursing facilities (SNF)
• Attach medical records to authorizations
• Monitor fax folders
• Follow up scheduling and re-scheduling of no-show appointments
• Assist nurse practitioner (NP) team with visit preparation needs
• Appointment reminders to members
• Assign members to NP in EHR
• Enter all medications and allergies in electronic health record (EHR)
• Provide needed documentation to NP for visits each day
• Maintain documentation on members contacted.
• Notify NP / nurse If members appear to be non-compliant or there appears to be a change in condition
• Assist with outreach activities to members in all levels of case management programs.
• Assist with maintaining and updating members' records
• Assist with mailing or faxing correspondence to PCP’s, specialists, related to, as needed.
• Attends case management presentations and participates, as appropriate.
• Recognize work-related problems and contribute to solutions.
• Meet specific deadlines by responding to various workloads, assigning task priorities according to department policies, standards, and needs
• Work with outside vendors to provide appropriate care needs for members
• Maintain confidentiality of information between and among health care professionals.
• Communicate with multidisciplinary teams
• Cover for other team members when needed (i.e. PTO, sick time)

Required Skills and Experience:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Minimum 1 year front office medical assistant, related experience, and / or training; or equivalent combination of education and experience.
• Experience entering referrals and prior authorizations (highly preferred)
• High school diploma or general education degree (GED)
• Medical Terminology Certificate preferred
• Knowledge of medical terminology
• Knowledge of ICD-9 and CPT codes
• Knowledge of managed care plans
• Computer proficient
• Able to type minimum 40 words per minute (WPM)
• Proficient in Microsoft Office (Outlook, Excel, Word)
• Knowledge working in Access Express / Portal, Epic, Essette preferred
• Read, write, and speak English fluently.
• Bilingual English and either Spanish or Vietnamese required.
• Strong written, verbal, and telephonic communication skills.
• Able to reason and carry out instructions.
• Good interpersonal skills.
• Good organizational skills.
• File systematically..
• Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Communicates effectively using good customer relations skills.
• Mathematical Skills: Able to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s. Able to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations.

Work Environment

The work environment characteristics described