Job Description

Onsite Shift 8;30 -5 3 Openings - Profession/specialty: Case Management Coordinator (2 Ambulatory and 1 Inpatient but possibly some cross coverage between the two) POSITION SUMMARY The Inpatient Case Management Coordinator plays a critical role in supporting case managers and social workers by coordinating care, managing documentation, and ensuring timely communication with members, providers, outside facilities and internal teams. The Case Management Coordinator will work closely with case managers, social workers, providers and interdisciplinary teams to facilitate care coordination. This position requires strong organizational skills, attention to detail, and an understanding of managed care processes to facilitate seamless transitions of care and optimize patient outcomes. The Case Management Coordinator assists with the management of members in PIH, Out of Network and SNF facilities. SPECIFIC SKILLS NEEDED High level of communication skills demonstrating courtesy and professionalism. Excellent organizational skills, problem solving and decision-making abilities. Strong attention to detail and ability to manage multiple tasks in a fast-paced environment. Proficient in Windows, Microsoft Word, and Excel. Minimum typing speed of 40 wpm Knowledge of medical terminology EDUCATION/EXPERIENCE/TRAINING Required: High school diploma or GED Minimum of two years of experience in health care field Preferred: Experience in case management, managed care, or healthcare coordination Spanish Speaking DUTIES AND RESPONSIBILITIES 1. Safeguards and preserves the confidentiality of patient s protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital, and departmental policies. 2. Ensures a safe patient environment and adherence to safety practices per policy. 3. With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational, and environmental needs of patient/significant other when administering care. 4. Update daily census reports by verifying member admissions and discharges. 5. Communicate with members via phone and in person to assess needs, triage concerns, and facilitate problem-solving. 6. Collaborate with case managers and social workers, including the leadership team as needed. 7. Verify member eligibility and benefits to support care coordination efforts. 8. Maintain understanding of managed care principles, risk arrangements, delegation of financial responsibility (DOFR) and compliance requirements. 9. Schedule member appointments and arrange transportation as needed. 10. Conduct follow-up calls with discharged patients to address ongoing needs and coordinate post-discharge care. 11. Enter and update all inpatient admission authorizations accurately. 12. Assist case manager with creating authorizations required for safe discharge. 13. Facilitate delivery and tracking of required forms to adhere to health plan requirements. 14. Prepare and distribute daily reports for patient rounds to ensure up-to-date patient information. 15. Receive, review, label, and file incoming faxes daily to maintain accurate records. 16. Ensure complete and accurate documentation in accordance with organizational and regulatory standards. 17. Assist in completing of health plan reports, ensuring accuracy, and maintaining up-to-date logs. 18. Collaborate with case managers and social workers, including the leadership team as needed. 19. Foster positive, professional relationships with physicians, facility staff, and colleagues. 20. Adhere to PIH Enterprise policies and procedures, ensuring high-quality customer service. 21. Work efficiently in a fast-paced environment, exhibiting strong multitasking abilities and attention to detail. 22. Engage in professional development by attending department meetings, completing required trainings and participating in process improvement initiatives. 23. Assist in training new hires to ensure a smooth onboarding process. 24. Provide coverage for team members as needed. 25. Perform other duties as assigned. TEAMWORK/CUSTOMER SERVICE RESPONSIBILITIES 1. Customer Service Values and Behaviors: 1.1 Value: Each person is treated with respect, dignity, fairness and compassion. Behavior: Performance is acceptable when everyone is promptly greeted with a smile in a warm and caring manner using the person s name whenever possible. No matter how I feel, I display a caring attitude. 1.2 Value: Each person displays loyalty and pride in PIH Health and upholds the confidentiality of patients, visitors, physicians, and co-workers. Behavior: Performance is acceptable when concerns/problems with fellow employees and customers are not discussed with anyone other than the person involved or the supervisor. Customer issues and ideas are listened to and appropriate follow up occurs to create a satisfied customer. I do not make excuses. I do not demean other people or departments. 1.3 Value: Each person demonstrates commitment to open communication. Behavior: Performance is acceptable when openness and acceptance of constructive criticism occurs. Positive communication occurs by complimenting and expressing appreciation to others. I will listen and encourage others to express ideas and opinions. 1.4 Value: Each person demonstrates pride in the physical appearance of all PIH Health properties. Behavior: Performance is acceptable when the initiative is taken to maintain a clean and safe environment. I conduct myself in a manner which respects and preserves equipment and the physical plant. I do not walk by spills, trash, or unsafe conditions without assuring that they are attended to promptly by me or appropriate personnel. PERSONAL QUALITIES Ability to recognize differing values and is culturally sensitive. Ability to make good decisions, set priorities and follow through on assigned tasks. Professional attitude and appearance. Commitment to the organization for which you work. Ability to maintain strict confidentiality. Interacts in a professional, courteous, and patient focused manner with all members of the organization.

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