Care Coordinator

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

Performs telephonic outreach and assessment of identified populations and provides coordination of community resources and support to Members and Providers across service areas. Identifies, facilitates, coordinates and advocates for Member access to services that enhance healthcare access and delivery by assisting in the coordination of safety net services that provide for basic needs such as education, housing, healthcare, legal, transportation and counseling assistance. Facilitates the acquisition of medications for patients to ensure compliance with medication regimens. Influences member engagement rates utilizing Motivational Interviewing skills and persuades Members to participate in Plan sponsored care management activities. Triages for and collaborates with clinical staff to ensure Members receive appropriate care. Supports one of the following care management programs: Sunny Start, Transition to Home, Population Health Management or Complex Care Management.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

* Supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate.

* Assesses member needs by conducting interviews and structured assessments using Motivational Interviewing techniques to engage Members and determine non-clinical and social needs and engage them in care management.

* Educates members by providing information on how to obtain resources, basic health information and by sending information packets to Members containing health information relative to the Member's identified conditions.

* Maintains current knowledge of community resources for referral and linkage to meet Members' needs

* Participates in group meetings to ensure policies, procedures, and work flows are up to date and advises on revisions needed.

* Facilitates member communication with external partners such as state agencies, community based organizations, clinical vendors, and primary care and specialty practices.

* Completes documentation in the medical management information system [JIVA] in a timely manner and in keeping with contractual requirements, internal policy and accreditation standards.

* Complies with established metrics for performance, adheres to documentation and work flow standards and utilizes other department specific tracking tools.

* Triages cases to clinical staff, other departments, contracted vendors and providers as appropriate.

* Participates as assigned in answering calls on the care management 800 line

* Program Specific Functions

* Transition to Home (TTH)

o Runs TTH census report admissions with TTH with Match Report and removes program ineligible members.

o Creates cases in JIVA and checks for discharge dates in JIVA by referencing the facility census or by contacting the facility.

o Telephonically outreaches to select full program members

o Calls short program members to ensure an appointment with the PCP or specialist has been set up within a week of discharge and assists member in making appointments as needed.

* Sunny Start

o Supports members to access necessary equipment such as breast pumps and infant car seats within members benefit structure

o Facilitates member access to and completion of prenatal and postpartum visits according to best practice guidelines and workflow standards.

Supervision Exercised:

* N/A

Supervision Received:

* Weekly and on-going from Manager of Care Management

Qualifications:

Education Required:

* Associate's degree or High School Diploma/equivalent and relevant work experience required.

Experience Required:

* 2 years of office experience, specifically in either a high volume data entry office, customer service calls center, or health care office administration department.

Experience Preferred/Desirable:

* Knowledge and experience in maternal child health.

* Experience with FACETS/JIVA or other healthcare database.

* Experience with care coordination or case/care management

* Prior customer service experience.

Required Licensure, Certification or Conditions of Employment:

* Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

* Motivational Interviewing skills

* Strong oral and written communication skills

* Ability to effectively collaborate with health care providers and all members of the interdisciplinary team

* Demonstrated strong organizational and time management skills

* Able to work in a fast paced environment and multi task

* Experience with Microsoft Office application, particularly MS Outlook and MS Word and other data entry processing applications

* Knowledge of medical terminology strongly preferred

* Knowledge of community resources strongly preferred

Working Conditions and Physical Effort:

* Regular and reliable attendance is an essential function of the position.

* Work is normally performed in a typical interior/office work environment.

* No or very limited physical effort required. No or very limited exposure to physical risk.

Compensation Range

$ 20.19- $29.33

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees