Managed Care Coordinator

The Care Coordinator for Managed Care Programs will support members of managed care insurance products to live safely and successfully in the setting of their choice. The scope of the coordinator’s work will be guided by contracts with managed care entities, and may include: assistance with care transitions, in-home safety assessments, service coordination and evidence-based programming. This position may require coverage of and some travel to areas outside of Somerville and Cambridge.

Job Responsibilities and Performance Standards:

  • Participate and complete the Coleman model for Care Transitions training and orientation sessions as assigned
  • Screen patients for eligibility based on contract guidelines
  • For the subcontract with Elder Services of Worcester Area (ESWA) with Blue Cross Blue Shield, maintain a caseload of patients throughout the course of the care transitions intervention (typically 30 days) and:
    • Provide each patient with a minimum of 1 in-home in-person visit within 7 days of discharge or referral utilizing the on 4 key elements of the Care Transition Intervention (CTI) Model.
    • Conduct 2-3 additional follow up phone calls to patients within 30 days post ED visit or admission, emphasizing the elements discuss in previous contacts
    • Identify required support services and provide information and referral to patients as relevant
    • When appropriate, utilize the appropriate systems for requesting 60 or 90-day extensions of enrolled patients
  • Initiate State Homecare referrals as needed and work with Assessment Team supervisor to hand off to the Homecare team.
  • Coordinate activities and communicate information with other ASAP staff (Ie. I&R, Homecare, AFC, PS, Volunteer Programs) when relevant
  • Participate in weekly meetings/rounds with clinical staff to discuss the status of enrolled patients
  • Ensure accurate and timely documentation in accordance with the contract(s) between SCES and an insurance product
  • Participate in activities to assist and promote SCES’ care transitions efforts in gaining visibility and trust with community agencies, hospitals, providers and the public.
  • Meet monthly targets including enrollments.
  • Complete contract requirements which may include obtaining and providing proof of certain vaccinations, PPD on an annual basis, drug screening, and not smoking.
  • Agree to follow the HIPAA regulations for each contract partner.

Professional Standards and Conduct:

  • Collaborative and Responsive: Regularly communicate, follow up, and use a team-driven approach. Respond thoughtfully and promptly to agency needs, requests, and inquiries; identify and build partnerships with key stakeholders. Demonstrates excellent organizational and time management skills to meet various deadlines, ensuring closed-loop communication. Ability to multi-task and maintain flexibility to adapt and adjust workload assignments based on various needs.
  • Communication: Skilled in verbal and written communication, demonstrating the ability to communicate information in various ways to meet diverse styles and cultural backgrounds.
  • Analytical: Critical thinking skills, using logic and reasoning to identify the strengths and opportunities of alternative solutions, conclusions, or approaches to problems.
  • Attendance and Punctuality: Dependable, punctual, showing flexibility when needed. Attends meetings as needed and is fully present and participates during those meetings.
  • Commitment: Embodies SCES’s core values and shows great integrity, accountability, and professionalism in all interactions. Aids in furthering SCES’s mission and commitment to an inclusive environment.

Qualifications:

  • Bachelor’s degree or Associate’s degree with significant relevant work experience.
  • Knowledge of the long-term care and social service delivery systems, community resources and the local service systems for elders and persons with disabilities required.
  • Experience working with older adults preferred.
  • Experience using Adobe and MS Word, Excel, PowerPoint, SharePoint, and other Microsoft 365 platforms preferred.
  • Use of a vehicle and current drivers license required.
  • Meets both CORI/SORI and public health screening requirements.

Physical Environment:

  • Physical surroundings are comfortable with minimal exposure to injury or hazards.

Social/Psychological Conditions:

  • Occasional stress due to periodic or cyclical workload pressures and deadlines. Some interruptions involved.

Physical Effort:

  • Frequently sits, stands, walks, bends, reaches, and stoops throughout the day.
  • Frequently lifts, pulls, pushes, and carries up to 20 lbs.
  • Periodic eye strain and light ear strain.