Job description
POSITION SUMMARY:
The role of the ACO Care Management Referral Coordinator is to process referrals and outreach to members to engage them in the Accountable Care Organization (ACO) Care Management programs. This role will accept and process referrals for multiple ACOs partnering with Wellsense Health Plan and BMC Health System Care Management Programs. This role operates at an advanced level of referral management and outreach, and requires familiarity with multiple program offerings. The person in this role will be able to effectively collaborate with clinical care managers, referring entities (providers and clinical care teams), and will be able to engage with patients telephonically. The ideal candidate will have experience working with Medicaid populations, individuals with mental health conditions, substance use disorder, and with a history of trauma. This role is also responsible for documentation in the electronic platform and complying with all data entry, data integrity, and data tracking requirements.
Position: ACO Care Management Referral Coordinator
Department: Population Health
Schedule: Full Time
ESSENTIAL RESPONSIBILITIES / DUTIES:
JOB REQUIREMENTS
EDUCATION:
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
EXPERIENCE:
KNOWLEDGE AND SKILLS:
This is a remote position that allows work from home. Candidates local to New England are preferred
Req id: 27182
The role of the ACO Care Management Referral Coordinator is to process referrals and outreach to members to engage them in the Accountable Care Organization (ACO) Care Management programs. This role will accept and process referrals for multiple ACOs partnering with Wellsense Health Plan and BMC Health System Care Management Programs. This role operates at an advanced level of referral management and outreach, and requires familiarity with multiple program offerings. The person in this role will be able to effectively collaborate with clinical care managers, referring entities (providers and clinical care teams), and will be able to engage with patients telephonically. The ideal candidate will have experience working with Medicaid populations, individuals with mental health conditions, substance use disorder, and with a history of trauma. This role is also responsible for documentation in the electronic platform and complying with all data entry, data integrity, and data tracking requirements.
Position: ACO Care Management Referral Coordinator
Department: Population Health
Schedule: Full Time
ESSENTIAL RESPONSIBILITIES / DUTIES:
- Connect and engage with BACO patients through outreach, enrollment, and scheduling activities. Responsible for all enrollment activities including:
- Working and prioritization of patient referral lists
- Conducting chart review to effectively triage the referral and clinical information
- Confirming ACO eligibility
- Referral to the appropriate care management program
- This role may also be responsible for outreaching and introducing program offerings available to the member
- Ability to connect members with local community resources for care management services.
- Establishes and maintains strong working relationship with internal and external partners
- Identifies opportunities for operational improvement and demonstrates willingness to try new approaches Serves as a representative of BMC Health System/BACO adhering to the highest professional standards, mission and values, and PHI requirements.
- Works collaboratively with other staff and leaders to advance the program, making every effort to meet established goals.
- Records and maintain tracking mechanisms and documentation supporting high quality hand-offs and reporting.
- Documents in care management system, EHR, and excel as required.
- Promotes an environment of teamwork and collaboration. Other duties as required.
- Must adhere to all of BMC's RESPECT behavioral standards.
JOB REQUIREMENTS
EDUCATION:
- Bachelor's degree in social work, human services, nursing, psychology, sociology, or related field; or
- Associate's degree and at least one year professional experience in the field; or
- Minimum of three years of relevant professional experience.
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
- None
EXPERIENCE:
- Care management experience preferred
- Referral coordination experience preferred
- Familiarity with Massachusetts Medcaid ACO model and care management programs required
KNOWLEDGE AND SKILLS:
- Knowledge of healthcare systems.
- Outstanding interpersonal skills and ability to communicate in a courteous, pleasant and professional manner with patients and families, general public, staff members, and other organizational leaders.
- Ability to establish and maintain positive working relationships.
- Experience in community health and outreach.
- Ability to work independently and to make decisions based on established policies and procedures.
- Demonstrated ability to work independently, manage multiple projects and prioritize in a fast-paced environment.
- Exceptional organizational and time management skills and ability to work independently and as part of a team.
- Excellent oral and written English communication skills.
- Fluency in Haitian Creole, Spanish, Mandarin, Cantonese and/or Portuguese preferable.
- Understanding of how language, culture and socioeconomic circumstances affect health
- Desire to work with diverse, multi-cultural and multi-lingual populations.
- Proficiency with Microsoft Office applications (i.e. MS Word, Excel, Access, Outlook) and web browsers. Proficiency with data entry and data tracking.
- Ability to coordinate efforts with other team members.
- Demonstrated prudent judgement and professional presence and demeanor.
- Creative problem solver.
- Ability to adapt to changes in healthcare delivery at local and systems level.
- Proven relationship-building skills, ability to participate in work teams.
- Reliability, commitment to setting and meeting goals is a must.
- Excellent interpersonal skills required to effectively develop and maintain strong working relationships across all levels of the organization.
- Ability to provide exceptional customer service to patients.
- Ability to engage patients' interest in meeting their health care needs.
This is a remote position that allows work from home. Candidates local to New England are preferred
Req id: 27182
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