Outpatient Care Coordinator III

Job Description

The Outpatient Care Coordinator III will be responsible for both program support and care coordination of members enrolled in the Outpatient Clinical Programs. Responsibilities include but not limited to processing new members for enrollment into outpatient clinical programs, screening incoming phone calls, completing post-discharge calls of enrolled members, and production and maintenance of department reports and internal trackers.

Responsibilities

Job Responsibilities/Duties

Screen incoming phone calls to determine urgency and direct calls to appropriate Medical Management staff.  

Conducts telephonic outreach to members to discuss and offer Outpatient clinical programs.

Requests and gathers necessary medical records to confirm program eligibility.

Coordinate care for members as appropriate such as scheduling appointments, creating authorizations to facilitate/expedite member’s request/s, etc.)  May carry a caseload of clinically stable members for routine check-ins. Escalate to the assigned case manager as appropriate.  

Timely processing of incoming referrals to Outpatient programs per set timeframes.

Reviews daily inpatient census to monitor for admissions/readmissions of current and potential members to be enrolled in Outpatient Clinical Programs.

Completes post-discharge calls for members per set timeframe. Determines additional post-discharge needs such as scheduling follow-up appointments, coordinating ordered DME and services, etc.  

Timely completion of assigned tasks in Case Management platform.

Mail out educational and community resources information to members.

Generate letters, fax to PCP, and mail to members along with resources and educational materials.

Interacts professionally with other healthcare providers, internal and external customers, and members when appropriate.

Responsible for timely and accurate production of reports and maintenance of internal department trackers.

Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.

Participates in internal and external meetings and present on report findings and trends to leadership and team as appropriate.

Maintains compliance with established departmental productivity guidelines.

Trains new team members in internal process.

Other projects and duties as assigned.

Qualifications

QUALIFICATIONS

Minimum Education: High School Diploma required. Associates Degree or higher preferred.

Minimum Experience: Minimum of two (2) years of experience in Case Management Care Coordination in an HMO environment; or any combination of education and experience which would provide an equivalent background required. Must be proficient in Microsoft Office navigation, Excel, Outlook, Teams, Word and other applicable systems needed for the role. Prior experience with Managed Care organization preferred. Knowledge of managed care and healthcare preferred. Bilingual language proficiency preferred. Ability to prioritize and multi-task. Excellent communication skills. Working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity, HMO, Medi-Cal and/or health services experience preferred. Maintain a professional attitude when working with internal and external customers.

Req. Certification/Licensure: Medical Assistant Certification preferred. Medical Terminology certificate preferred.

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.