Job Summary:
The Care Coordinator - Massachusetts at CareSource/Commonwealth Care Alliance is the primary point of contact for a stratified panel of members whose role is to assist enrollees in navigating their health care providing care planning and coordination of services, ensuring timely service delivery and prompting continuity of care through coordinated outreach and engagement with members and providers. This role is responsible for routine enrollee outreach, including community-based visits, telephonic or virtual visits, documenting service activities, and supporting administrative functions that enhance member satisfaction.
Essential Functions:
Serve as the first point of contact for enrollees, including assisting enrollees with understanding health plan processes, appeals and grievances and assist with removing barriers to getting needed services
Conducts routine outreach to members and providers to confirm service details, coordinates services with long term services and supports teams, , serves as a health plan subject matter expert and accurately documents care coordination activities.
Provides in-person visits to enrollees at least annually, with member consent
Maintain open lines of communication with enrollees, as needed based on Enrollee preferences
Maintains accurate and timely documentation and internal systems to ensure visibility across teams and continuity of service.
Coordinates provider and member scheduling efforts, supports high-volume outreach campaigns, and ensures task completion across multiple systems
Identify potential social support or community-based needs
Lead the interdisciplinary care team (ICT) for a stratified panel of members, collaborating with team members internal and external to the organization to create an enrollee centered care plan
Provide education on plan benefits and service options
Serves as a support resource for enrollees and providers, and escalate concerns by coordinating responses and ensuring issues are routed or addressed promptly
Collaborates with clinical care managers, behavioral health clinicians, community health workers, providers, and external partners as needed to ensure smooth communication and continuity across care activities
Gather and document service-related information during members interaction to support care coordination, service planning, or referral processes
Maintain accurate documentation and maintenance of the centralized enrollee records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners as needed
Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements
Ensure enrollees follow up with providers, including assistance with appointment scheduling and verification of transportation
Facilitate communication and information exchange with the member and their providers and community supports
Performs any other job related duties as requested.
Education and Experience:
High School or GED required
Two (2) years of experience in healthcare, customer service or a related industry required
Competencies, Knowledge and Skills:
Basic proficiency with Microsoft Office Suite to include Outlook, Word and Excel
Knowledge of Medicaid, Medicare and Managed Care is preferred
Customer service focus with exceptional listening, written and verbal communication skills
Displays professional phone etiquette
Ability to multitask using a variety of computer applications
Strong organizational skills
Effective problem solving skills with attention to detail
Ability to work independently and within a team environment
Understanding and supportive of managed care concept
Adaptable to a constantly changing environment
Able to type (document) and talk (telephonically) simultaneously
Licensure and Certification:
Must have valid driver's license, vehicle and verifiable insurance. Employment in this position…