Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities.

At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

Job Summary

This individual must be able to plan, organize, and prioritize work to ensure completion in a timely manner. He / she functions as a key contact and department representative of the Point32Health Senior Products Care Management Community values to both internal and external customers of the care management department through both verbal and written communications.

Under the administrative direction of the Supervisor of Administration, the Care Coordinator (CC) performs activities that support the clinical, business and program related work of the case managers (CM) and the management team.

The Care Coordinator is a key member of the case management team who performs complex administrative duties, adjunct to the role of the case manager with minimal supervision.

Key Responsibilities / Duties - what you will be doing

Support the General Case Management Process within Case Management Department :

• Initiates requests for clinical information from inpatient providers within department timelines
• Accurately identifies when to escalate issues which may prevent meeting department timelines for completion of notification to providers for denials and for requests for information
• Track and manage member needs within the defined intervention period for the member specific population, complete follow-up responsibilities within required timeframe
• Provide education and coaching to the member, family, and / or caregiver about follow up care and health status, goals of transition care, and health insurance benefits to assist members in making the most informed decisions and to promote self-management of care
• Ensure timeliness in coordination of health care services. Assist members with scheduling appointments, tests, screenings, and transportation.
• Assist execution of special projects and outreach campaigns
• Under direction of registered nurse, influence course of care

Performs general office duties :

Such as sorting departmental mail, filing, faxing, photocopying, researches addresses / member contact information as necessary when typing labels and envelopes.

Manages and assures adequate Disease Management material mailing inventory.

• Employ multi-tasking skills when multiple deliverables are due
• Sorts copy requests separating Copy Center requests from routine jobs. Completes all Copy Center Request forms and submits to the Copy Center for large copy production jobs.

Follows-up with the Copy Center on rush jobs. Copies and distributes small copy requests. Organize copies of documents in binders and / or prepare for mailings.

Central Contact for Nurse Practitioners for HMO / SCO :

• Calls members to setup NP assessments utilizing the language line as needed
• Scheduling translation services for in home visits by NP
• Maintains calendar of NP assignments, communicates according to policy
• Accurately identifies any issues to escalate to a Team Leader

Provides departmental process support in duties unique to assigned service operations area .

Attends scheduled meetings and assigned training sessions.

Qualifications - what you need to perform the job

EDUCATION : (Minimum educations & certifications required)

• High School degree required.
• Associate degree in business and / or completion of Medical Assistant / Medical technology / LPN program is highly desirable.

EXPERIENCE : (Years of experience)

• 3-5 years experience in a professional environment required.
• Experience in a health care environment, especially in managed care is highly desirable.
• For internal applicants, experience required in CCMS, MedHok, CaseTrakker, Diamond and Macess.
• External applicants must demonstrate potential to become proficient within 3 months of training.

SKILL REQUIREMENTS : (Include interpersonal skills)

• Proficiency required in Microsoft Word, Excel, in an e-mail program and the Intranet. Experience in Power Point, Access, Visio and other software applications desirable.
• Work independently and cooperatively as a team member across multiple levels within the organization
• Must have a commitment to excellence in customer service
• Must have well developed written and verbal communication skills
• Ability to identify emergency situations and follow the established protocol
• Ability to handle multiple demands and must be able to balance multiple priorities within set protocols and procedures.
• Strong organizational skills to be able to handle a routine workload and multiple tasks while maintaining excellent customer service
• Ability to increase workload and be flexible with coverage responsibilities in order to meet strict department deadlines
• Strong knowledge of Clinical Services' departments and THP organizations in order to accurately and quickly assess situations and direct internal and external customers appropriately
• Must project a professional and mature demeanor and accept direction as needed
• Must consistently exercise sound decision-making skills as necessary.
• Regard for confidential data and adherence to corporate compliance policy

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel,

overtime)

• Fast paced office environment handling multiple demands independently
• Must be able to exercise sound judgment as necessary and to work and communicate with customers in a telephonic office environment.
• A cubicle based work environment, which presents challenges to maintaining focus on the work while exposed to others voices and work sounds.
• Ability to enter data and type the information received during a telephone conversation.
• Ability to carry 5 - 25 pounds of materials from one business area to another, approximately a distance of 100 yards
• Digital and manual dexterity required for keyboard along with ability to work on a display monitor for long periods of time
• Overtime and flexibility of hours may be required on an as needed basis.

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Medical, dental and vision coverage

Retirement plans

Paid time off

Employer-paid life and disability insurance with additional buy-up coverage options

Tuition program

Well-being benefits

Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https : / / www.point32health.org / careers / benefits /

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do-from product design to the workforce driving that innovation.

Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts.

Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent.

We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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Last updated : 2024-05-24