Population Health - Care Coordinator

UNM Medical Group, Inc. is hiring for a Care Coordinator to join our Population Health team! This opportunity is a full-time, day shift, On-site opening located in Albuquerque, New Mexico.

* This position is 100% On-site*

Minimum $44,604 - Midpoint $55,766*

* Salary is determined based on years of total relevant experience.

* Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE.

The Population Health Care Coordination team currently consists of three care coordinators who pride themselves on providing excellent customer service to our self-funded medical benefit participants and health system patients.

The successful incumbent must have the ability to work independently in a contact center environment with strong critical thinking skills, effectively assist the needs of the customers and patients we serve, and willingness to adapt to changing priorities.

This ideal candidate is detail-oriented, has strong written and verbal communication skills, and handles sensitive information with discretion and confidentiality and the ability to report in office 100% of the time.

Preference will be given to candidates who have prior contact center experience and/or working in the health plan payer environment.

The Population Health Care Coordinator performs data informed patient outreach to close gaps in care and improve patient outcomes for UNM Health System patients. They will also provide direct customer service to health plan participants and providers through care coordination, referral management, appointment scheduling, prior authorizations, claims, and billing inquiries, as appropriate.

The Population Health Care Coordinator performs data informed patient outreach to close gaps in care and improve patient outcomes for UNM Health System patients. They will also provide direct customer service to health plan participants and providers through care coordination, referral management, appointment scheduling, prior authorizations, claims, and billing inquiries, as appropriate.

High school diploma or GED with at least 4 years of experience related to the duties and responsibilities specified. Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis

Verification of education and licensure (if applicable) will be required if selected for hire.

• Perform attribution, quality, and scheduling outreach.
• Aid UNM Health System Primary Care Clinics with gaps in care closures for value-based contracts and quality reporting.
• Communicate patient needs to clinical staff to facilitate positive patient outcomes and experience.
• Review outreach reports, validate content, and provide feedback to improve future outreach efforts.
• Assist in attribution updates between health system, patient, and MCOs.
• Assist in scheduling diagnostic tests per primary care standing orders.
• Collaborate with Panel Management to maintain panel integrity.
• Perform chart reviews prior to outreach to ensure familiarity with the patient's medical needs and confirm appropriate outreach. Assist in the development implementation, and documentation of, programs, and projects to accomplish department goals.
• Research customer complaints/inquiries, facilitate resolutions, and document encounters; provide plan information and assistance to members to ensure maximum coverage and benefit reimbursement.
• Verify coverage; obtain medical record information; and submit required forms for review; document in the appropriate software.
• Facilitate and coordinate acute care, primary care, specialty appointments, referrals, and medical equipment, etc., perform follow-up communication with members or designees as needed.

The Office of Population Health Management supports the Health System's transition to value-based care and ensures regulatory compliance. We use data analytics to improve care delivery throughout the UNM Health System. Our team works…