JOB TITLE: Care Connections Specialist
FLSA STATUS: Non-Exempt
HOURS PER WEEK: 40
REPORTING RELATIONSHIP: Care Connections Coordinator
SUMMARY of DUTIES:
Care Connections Specialist (CCS) facilitates communication between members, affiliates, medical practitioners and clinicians specializing in the fields of Developmental Disability, Mental Health, Substance Use, Social Determinants of Health, and primary care within and outside the CBHS network. The CCS primary responsibilities are facilitating the referral process and coordinating the credentialing process. The CCS is responsible for processing referrals so that referring provider, practices, hospital systems, or managed care organizations successfully connect their clients to the services provided by CBHS members and affiliates. The CCS coordinates referrals so that clients get connected to the most appropriate member agency following a prescribed referral algorithm. The CCS also ensures that the referring provider gets whatever information they need to “close the referral” and to facilitate whatever level of communication is needed between the referring provider and the CBHS network. The CCS ensures all CBHS, HCBS, HIPAA, 42 CFR, and Corporate Compliance guidelines and regulations are followed.
SPECIFIC DUTIES and RESPONSIBILITIES:
1. The Care Connections Specialist works in collaboration and continuous partnership with clinics/hospitals/specialty providers/community-based organizations and their staff within the network to ensure coordination through communication.
2. The CCS plays an integral role in achieving the performance outcomes of the contracts, grants and projects CBHS is engaged in.
3. Promotes timely access to appropriate care and increases utilization of preventative care.
4. Increases continuity of care by managing relationships with providers, transitions-in-care and referrals.
5. Connects member with relevant resources, with the goal of enhancing patient health and well-being, increasing patient satisfaction and reducing health care costs.
6. Serves as the primary contact point for the referral process and a resource of information regarding services provide throughout the CBHS network.
7. Ensures timely communication, inquiry, follow-up, and integration of information regarding the transition of care and referrals.
8. May need to be available for service on a 24-hour on-call basis, if required.
9. Attends all necessary and relevant training courses, webinars and meetings to fulfill the position’s responsibilities.
10. Provides feedback for the improvement of the Care Connections Program.
11. Devises workflows for the receipt of and the coordination of all referrals to include notification of payor and services covered.
12. Responsible for completing daily logs and notes to ensure continuity of care, documentation of referrals, use of algorithm and timeliness of services.
13. Maintains high level of customer service satisfaction in each interaction with providers and clients.
14. Uses discretion and independent judgement in handling client or provider complaints received, document and forward to appropriate administrative staff.
15. Communicates with supervisor any relevant information received from agency, client or employees about members’ care or needs.
16. Requests and records all pertinent clinical information provided; electronically enters data for all calls, to include demographic data, service provided, and disposition; maintains daily statistics on types of calls received.
17. Assists in maintaining a CBHS service directory of member information, in order to expedite the referral process.
18. Responsible for ensuring healthcare personnel are credentialed with proper licenses and certifications mandated by state and federal regulations.
19. Performs miscellaneous job-related duties as assigned.
REQUIRED KNOWLEDGE AND SKILLS:
1. Evidence of essential leadership and communication skills (oral & written).
2. Proficiency in communication technologies (email, cell phone, etc.).
3. Highly organized with ability to keep accurate notes and records.
4. Ability to manage multiple projects and variety of tasks.
5. Experience with health IT systems and reports is desirable.
6. Local knowledge about and connections to community health care and social welfare resources is desirable.
7. Customer/Client Focus.
8. Knowledge of medical terminology and procedures.
9. Must have a high school diploma or equivalency.
10. Credentialing experience preferred.
Electronic health record experience (preferred).
Ability to react calmly and effectively in emergency or high stress situations.
Ability to operate a multi-line telephone system.
Knowledge of customer service standards and procedures.
Ability to make administrative/procedural decisions and judgments.
Ability to independently resolve client complaints and concerns.
Call Center or Intake experience (preferred).
Experience verifying insurances (preferred).
Organizing and coordinating skills.
Computer data entry skills.
Please visit www.indeed.com to apply or submit your resume to: firstname.lastname@example.org