Care Management Coordinator

WellCare Health Plans, Inc. (NYSE:WCG) a Fortune 1000 company, is the nation?s leading provider of government health insurance products dedicated to government-sponsored health plans such as Medicare, Medicaid, State Children?s Health Insurance Programs, Medicare Prescription Drug Plans and others. Founded in 1985, our team of 2,500 associates and over 20,000 physician partners serve over 2 million members across the U. S. Our company headquarters are based in Tampa, FL. For more information about WellCare, please visit the Company?s website at www.wellcare.com.

 

We are looking to add a Care Management Coordinator to our Health Services team.  If you truly believe in teamwork, consistently demonstrate a high level of integrity and want to be a part of a dynamic, growing organization, then this may be the opportunity for you.

 

Job Summary:

Provides support and project management for the Care Management Market Manager and Care Management Department.

 

Essential Functions:Under Manager supervision, receive, research, review, streamline, process and track all incoming Case Management referrals and Pre-Authorization requests and forward these referrals to the specific HS team Support and Manage Case Management Special Projects and Reports including FL Specialist and Ancillary Providers Termination Member Letters, NY LifePlans Program, Hospice, CMS and HTP Conversion Programs and Harmony IL Transition of Care ProgramMaintain accurate Concurrent Review, Pre-Authorization and Case Management reports as needed by the departmentDistribute healthcare service requests from provides to appropriate clinical team memberObtain concise information such as member and provider eligibility, status, benefit coverage and coordination of benefits as needed to review Case Management and Pre-Authorization Requests in a timely and cost-effective mannerConduct outreach calls to members that may be potential case management members Support the nursing staff in notifying providers of medical referral authorizationsReceive, research, review, streamline and process all incoming member Health Risk Assessment questionnaires into the Paradigm Customer Service QRT system using WellCare Health Services guidelines Assist in resolving member, provider and vendor complaints related to medical service authorizationsServe as a liaison in corresponding and communicating with members, providers, vendors, WellCare internal and external contacts and/or members? representativesCoordinate Care Management Meetings including preparing the agenda, notifying participants and maintaining a log of meeting attendeesCompletes and assist special projects or including preparing and submitting projects, reports or assignments as needed to meet department initiatives and objectivesMaintains all department files in an organized, accurate mannerInterpret and convey a variety of instructions furnished in written and oral form

 

 Additional Duties:Provide technical and administrative support to Medical Directors and upper management staff as neededOrganize a variety of administrative and clerical tasks and prioritize job tasks in order of importance and impact on members and providers and other WellCare clients as neededDevelop and present new ideas for performance and process management improvement within the departmentAssist clinical staff with member transition of care/continuity of care coordinationProvides back-up to Denial Coordinator and Disease Management Coordinator and other Team Care Management Coordinators as needed to avoid department back-logAnswer routine telephone calls and direct to appropriate personRetrieve and distribute faxes Maintain office supplies; track and notify AA if additional inventory are neededOperate general office equipment including faxes, PCs, telephones, and printers with no assistance requiredSort, receive and send mail and correspondence to members, providers and WellCare clients

 

Knowledge, Skills, Abilities Required:Demonstrate knowledge of Medical Terminology, CPT-4 and ICD-9-CM codingAssist in evaluating process improvementsWork with manager to prioritize workload and seeks help in managing workload when appropriateAdapt to changes in policies, procedures, new techniques and additional responsibilities

 

Education/Experience:  High School Diploma, Certification of Medical Assistant Program and/or equivalent experience.  Associate?s Degree preferredMinimum of three (3) years work experience in an HMO, medical office or facility settingMinimum of three (3) years administrative and clerical work experience

 

Communication and Numeric Skills: Creates a positive image by positive attitude toward the organization and in dealing with customers and co-workersDelivers verbal and written communications that are clear, concise, complete, and demonstrate professionalism and diplomacyObjectively listens to customer requests or complaints; seeks clarification as needed and responds promptlyBasic analytical and mathematical skills

 

Computer Skills:Experience with Paradigm Systems and Sidewinder Application to at least an intermediate levelWorking knowledge of email systems such as Microsoft Outlook sufficient to communicate with internal and external contacts and generate electronic meeting reminders and updatesWorking knowledge of Microsoft Word sufficient to create moderately complex documents that may contain formatting, headers, footers and tablesWorking knowledge of Microsoft Excel sufficient to create moderately complex spreadsheets containing formulas, links and graphsWorking knowledge of Microsoft Access sufficient to update and run reports for Care Management TeamWorking knowledge of Microsoft Visio and PowerPoint sufficient to create intricate electronic presentations, work organizational charts and workflows Working knowledge of the Softheon Scanning System sufficient to send and access scanned documentsMinimum typing skill of 60 wpm and 10 key-by-touch abilityWorking knowledge of personal computers sufficient to provide team members initial technical support