Patient Care Coordinator - Remote

JOB SUMMARY

The purpose of the Patient Care Coordinator (PCC) is to provide non-clinical assistance within the Medical Management department, as directed by the Manager / Supervisor. The PCC will assist with identification of barriers to member’s care, working with the clinical team to locate and assess resources needed to help manage a patient's healthcare and treatment needs.  This position may assist either the Utilization Management or Case Management teams.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Assist clinical staff with members inpatient or case management needs by:
  • Requesting clinical information from providers
  • Assuring discharges are place in the system in a timely manner
  • Track SNF denial letters for signature and date
  • Work with Facility and Medical Director to set up requested peer-to-peer post-denial discussions
  • Assist with coordination of member’s health care and social service needs both within and outside the Medical Group and Health Plan. 
  • Develop rapport, establish and maintain effective interpersonal relationships with internal and external contacts at all levels. Coordinate the timely resolution of member and Provider concerns.
  • Outreaching members post-discharge to assist determine if requested resources are provided
  • Facilitate communication of the member Health Risk Assessment (HRA) and initial care plan (ICP) to the primary care physician (PCP). 
• Communicate effectively, both verbally and in writing with individuals from varying cultural and ethnic backgrounds. 
• Responsible for working closely with manager to address issues and delays that can cause a failure to meet or maintain compliance.
• Meets or exceeds production and quality metrics.
• Work directly with the provider(s) and plan to facilitate quality service to the member and provider.   
• Attend all mandatory meetings and training.
• Maintain and keep in total confidence, all files, documents and records that pertain to the business operations.
• Collaborate, educate and consult with other departments to ensure consistent work processes 
• All other job-related duties as it relates to the job function or as delegated by the management team.

KNOWLEDGE, SKILLS, ABILITIES

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.

• One year Managed care experience (HMO, Medi-Cal/Medicare, Long Term Services and Supports and Community Health services) preferred. 
• Experience in customer service. 
• Problem solving and analytical skills. 
• Ability to speak second language is preferred. 
• Knowledgeable in principles and techniques to serve populations in diverse social and ethnic groups.
• Ability to communicate effectively both verbally and in writing.
• Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel 

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Minimum Education: High School Diploma / GED Required
• Preferred Education: Associate Degree
• Equivalent clinical work experience considered.

REQUIRED CERTIFICATIONS/LICENSURE

Include minimum certification required to perform the job.

• Preferred: Medical Assistant certification

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.              

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT 

The work environment characteristics described here are representative of those an employee encounters while p