Outpatient Coordinator Lead

Position Summary:

The Outpatient Coordinator Lead is responsible for navigating the care management across the continuum of care of the member from acute to outpatient case management. The Outpatient Coordinator Lead’s role is to incorporate administrative job functions to provide optimal care and coordination of care for members. The Outpatient Coordinator Lead will assist the case management team in care coordination during the transition of care levels. The Outpatient Coordinator Lead will be responsible for developing relationships with members and providing support, encouragement, and health education.  Responsibilities include but are not limited to assisting in scheduling medical appointments, durable medical equipment, home health, eligibility/benefit verification, requesting medical records, data entry, review of medical management reports, and referral processing as needed. The Outpatient Coordinator Lead will work closely with nurse, doctor, and management staff to coordinate care for members delegated or assigned. The Outpatient Coordinator Lead is responsible for coordinating non-clinical tasks to support the delivery of care coordination to members who meet case management criteria.  The Outpatient Coordinator Lead promptly, efficiently and accurately processes referrals as needed. Facilitating the right care at the right time in the right setting. Maintain turnaround time compliance in all aspects of the referral processing as part of care coordination with members primary care physician/specialist. Promote the quality and cost effectiveness of medical care through adherence to UM Policy and procedure. The Outpatient Coordinator Lead will maintain and complete work within due dates/timelines based on regulatory compliance expectations. Expected to promote excellent team work by collaborating in process improvement efforts. The Outpatient Coordinator Lead is responsible for conducting calls to members to engage into case management programs. Collaboration with doctor’s office for referral processing requests and or expediting referrals. Participation in quality audits for the coordinators as well as attendance of Health Plan Audits. Creation of job aids and tools for the department. Serves as preceptor in the team. Collaborates with Leadership in process improvement.

Essential Duties and Responsibilities include the following:.

• Ability to remain positive in a fast paced environment
• Documents clearly and concisely in members file using directed documentation style
• Ability to time manage in a high work environment
• Follow process protocols efficiently and report any areas of process improvement to leadership
• Adaptability to consistent process changes
• Ability to remain organized throughout the day to allow quality and productivity.
• Ability to maintain, read, respond to all outlook communication in a timely manner.
• Maintenance of Fax Servers as delegated
• Able to use system resources to increase productivity and organization
• Ability to recognize and communicate when assistance is needed and ability to assist others when time is available but also when instructed to do so.
• Adherence to timekeeping policy expectations
• Welcome constructive criticism as an opportunity to learn and grow
• Communicate in a clear and concise manner
• Follow best practice email etiquette with HIPAA best practices
• Ability to use chain of command when escalating barriers
• Coming up with innovative solutions and proposals to leadership
• Ability to use critical thinking and problem solving
• Demonstrate integrity and character in the face of overwhelming challenges
• Ability to take responsibility over member and tasks and resolving issues timely
• Responsible for contacting members to provide necessary wellness education to improve self-management skills and enhance patient provider communication.
• Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of involvement they need.
• Returns phone calls to customers and follows up with requests in a timely manner.
• Ability to maintain high call volume; incoming and outgoing calls.
• Assists other staff and supports the team approach.
• Demonstrates honesty and integrity in everyday activities.
• Protects privacy for both patients and employees; ensures all personal health information is kept confidential i.e., (sensitive papers, charts, and reports are not in view of the public).
• Recognizes when an error has been made and immediately reports to appropriate management staff.
• Participates in “service recovery” through follow-up with an upset customer, gathering information, and demonstrates empathy