We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Outpatient Care Coordinator I is responsible for timely processing of Outpatient Clinical Programs cases including, but not limited to, gathering of pertinent medical records, validation of eligibility, completion and/or review of health risk assessments, establishing member-friendly care plans, scheduling of interdisciplinary care team (ICT) meetings, and submission of documents to delegated health plans.

Job Responsibilities/Duties

• Conducts telephonic outreach to members to discuss and offer Outpatient clinical programs.
• Requests and gathers necessary medical records as needed.
• Validates patient eligibility, benefits, and medical group affiliation.
• Administers and/or review Health Risk Assessment and identify member’s coordination of care needs.
• Established basic health care goals with members.
• Collaborates with the health plan, PCP, and health care team to ensure timely communication of member's clinical information.
• Works closely with case managers in the development of member-friendly care plans for each member, incorporating the HRA and all other assessment findings.
• Facilitates warm transfers to member's assigned case manager in accordance with member needs, when appropriate.
• Schedule and coordinate interdisciplinary care team (ICT) meetings including sending invitations to members, caregivers, PCP, specialists, and other members ICT team per set timeframes.
• Maintains documentation of member's case, care plan, interventions, and interdisciplinary care team within Prospect’s care management system.
• Compile clinical documentation as required for ICP/ICT bundle submissions per set timeframes.
• Generate letters, fax to PCP, and mail to members along with resources.
• Maintains compliance with established departmental productivity guidelines.
• Maintain internal department trackers and reports.
• Other projects and duties as assigned.

Qualifications

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

Minimum Experience: Minimum of one (1) year 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. Prior experience with Managed Care organization. Knowledge of managed care and healthcare.

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

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/