Care Coordination Specialist

Stony Brook University•Stony Brook, NY

About The Position

Navigation of WTCHP benefits is essential to the care of our population. The Care Coordination Specialist is the primary connection for our patients to their WTC Health Program health services. The WTC Health Program offers our patients a limited health care coverage program and the role of a Care Coordination Specialist is to work with the patients who are eligible for treatment to ensure access and participation in their member benefits. Our Care Coordination Specialists ensure the success of quality care management through their management of key areas. Care Coordination Specialists liaison with in-network providers to ensure required documentation, medical justification and member eligibility to authorize care through the WTC Health Program. The network is specific to the WTC Health Program and is both vast and limited. The benefits are however restricted to approved services that relate to WTC certified conditions. Successful care coordination requires balancing the member’s needs with the limitations of the coverage and identifying barriers to care access, resolving issues and promoting participation. The Care Coordinators further ensure all program rules are enforced to prevent fraud, abuse and waste of WTC Health Program resources. The role of the Care Coordination Specialist is to lead the department by managing key areas of care coordination (e.g call center and DME) to ensure high quality services, this includes: handling the most complex patient issues and providing coaching, mentoring and training to the care coordinator team. The Care Coordination Specialists rely on important tools such as the WTCHP list of network providers, codebooks and formularies to ensure high quality care coordination for the members. Care Coordination Specialists operate a call center for member inquiries and complaints. The Care Coordination Specialist manages complaints and issues by utilizing a variety of interpersonal, communication, problem solving, motivational and negotiation skills to identify and resolve patient issues. The ideal applicant should have strong computer skills and a high level of organization. The ideal applicant should also have strong interpersonal and communication skills and be able to make independent decisions and prioritize patients based on needs and time requirements.

Requirements

Bachelor's degree (foreign equivalent or higher).
Two (2) years of full-time experience working in a medical office environment.
Experience with data collection, data management and data record keeping.
Experience working with electronic health record management systems (EMR).
Experience assisting patients with navigating provider networks.

Nice To Haves

Master’s degree (foreign equivalent or higher) in Public Health or related field.
Experience in care coordination, patient relations, patient advocacy and/or customer service in a medical benefits coordination role.
Knowledge of private or government insurance plan management.
Experience working with a trauma-exposed population, or dealing with patients with a combination of complex medical, mental health and communication needs.
Knowledge of World Trade Center Health Program requirements.

Responsibilities

Operate Call Center: Manage inquiries and complaints from patients regarding their benefits, and access to care.
Provide patient-specific program benefits education and guidance to ensure patient understanding of available benefits.
Assist patients in navigating a vast provider network to identify a provider that fits patient’s needs.
Manage difficult patient conversations (particularly with members in medical crisis, mental health or cognitive related needs).
Provide clear program guidance serving as a liaison between members, care givers, clinical providers, and both internal and external medical staff to resolve difficult situations constructively utilizing sound judgment.
Coordinate care with outside providers to ensure that the member can access appropriate care and that proper authorizations are in place prior to care.
Follow-up with patients seeking certification of health condition for coverage through the WTC Health Program and ensure referrals and authorizations are in place and patients care is coordinated upon certification.
Charged with day-to-day organization and management of a special project(s) within Care Coordination (examples include: DME, Certifications, Mental Health liaison, referral and auth management).
Provider peer leadership to team members.
Prepare and analyze tracking contact logs, authorization logs, EMR and manage a variety of pools and worklist to ensure concise and accurate real-time patient records for Management, Quality and auditing purposes.
Ensure timeliness of response to patient issues and requests.
Ensure all program related records are stored appropriately in the EMR. Conduct internal data quality control to prepare patient records for sponsor audits.
Other duties as assigned.