San Francisco Health Plan: About Us: Jobs: Care Management Coordinator

Care Management Coordinator

The Care Management Coordinator is responsible for working with a multi-disciplinary team, serving primarily in an administrative support capacity. The duties of this position include making telephone calls to members and providers, as well as data entry. The position provides opportunities to work on case management, disease management, community outreach projects and assisting with utilization management and pharmacy authorization requests, contingent upon departmental needs. This position will be cross-trained in several key positions within the Medical Management department.

ESSENTIAL DUTIES & RESPONSIBILITIES

Provides administrative assistance and makes initial phone calls for a collaborative pilot project to call members with diabetes, coach them on self-management goals, and respond to triggers from an automated telephone self-management system.
Participates in making member phone calls working from a script, and identifying when calls need to be referred to a clinician for review.
Refers cases to a clinician, including the Medical Director, for clinical review, potential denial or modification and physician provider education
Provides administrative and clerical support for case management, disease management and utilization management activities
Answers questions and resolves issues promptly from providers, office staff, and pharmacy staff pertaining to medical supply benefits, formulary and preauthorization requirements.
Ensure the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.

CORE COMPETENCIES / KNOWLEDGE & SKILL REQUIREMENTS

Detail-oriented, highly organized, and able to work with multiple team members and departments.
Ability to communicate effectively (spoken and written) with internal and external parties.
Computer competency in using Microsoft Office applications including Outlook, and Excel. Familiarity with databases such as ACCESS a plus.
Current Medical Assistant certification or California Pharmacy Technician License or equivalent experience in a health care field with familiarity with basic medical terminology and concepts strongly preferred.
Ability to work with a socially and ethnically diverse population.
Bilingual verbal skills (e.g. Cantonese or Spanish) required, written skills a plus.)
Reliable and punctual.

EDUCATION, EXPERIENCE & TRAINING REQUIRED

BA/BS in Social Sciences, Life Sciences, Business, or a related field, preferred.
Experience in an HMO or experience in managed care setting, a plus.
Knowledge of and experience with state and federal insurance programs, a plus.
Experience with Medi-Cal and/or California Department of Health Care Services regulations and standards desired.

WORKING CONDITIONS

Standard office environment without unpleasant or hazardous conditions. Work entails typical physical demands involved in office work.

NOTE: This description is not intended to be construed as an exhaustive list of duties, responsibilities or requirements for the position. This position may change or assume additional duties at any time. The employee may be requested to perform different or additional duties as assigned.

San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V

Interested parties please apply here:
https://home.eease.adp.com/recruit/?id=564896