Remote Care Coordinator, Transition of Care, Bilingual Spanish

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve.

In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Care Coordinator works in collaboration with the RN Case Manager as part of the interdisciplinary team. The Care Coordinator supports members with closing care gaps and addressing care coordination needs as directed by the RN Case Manager. The Special Needs Plan (SNP) team is responsible for the health care management and coordination of care for members with complex and chronic care needs.

GENERAL DUTIES/RESPONSIBILITIES (MAY INCLUDE BUT ARE NOT LIMITED TO):1. Reaches out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc.
2. Creates cases, tasks, and completes assessments in Case Management module for all Hospital and SNF discharges
3. Complies with tasks assigned by nurse and, as appropriate, documents accordingly
4. Works as a team with the Case Manager to engage and manage a panel of SNP members
5. Manages new alerts and updates Case Manager of change in condition, admission, discharge, or new diagnosis
6. Establishes relationships with members, earns their trust and acts as patient advocate
7. Escalates concerns to nurse if members appear to be non-compliant or there appears to be a change in condition
8. Assists with outreach activities to members in all levels of Case Management Programs.
9. Assists with maintaining and updating member’s records
10. Assists with mailing or faxing correspondence to members, PCP’s, and/or Specialists
11. Requests and uploads medical records from PCP’s, Specialists, Hospitals, etc., as needed
12. Attends Interdisciplinary Team Meetings and participates in member presentations as appropriate.
13. Meets specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs)14. Maintains confidentiality of information between and among health care professionals
15. Other duties as assigned by CM Supervisor, Manager or Director of Care Management

Job Requirements:

Experience:

•

Required:

Minimum 1 year experience working in Health Care IPAs. Minimum 1 year experience entering referrals and prior authorizations.
• Preferred:

Education:

•

Required:

High School Diploma or GED. Bachelor's degree or four years additional experience in lieu of education.
• Preferred: MBA Training:
•

Required:

• Preferred:
Medical Assistant training, Medical Terminology training.

Specialized

Skills:

•

Required:

Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Communicates effectively using good customer relations skills.

Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.

Problem-Solving

Skills:

Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

Knowledge of Managed Care Plans Knowledge of Medi-Cal Basic Computer Skills, 25 WPM (Microsoft Outlook, excel, word)
Mathematical

Skills:

Ability to add and subtract two digit numbers and to multiply…