Medical Management Coordinator

Job Purpose

The Medical Management Coordinator is responsible for works collaboratively with team members and independently to provide care management to HealthTexas members. In addition, you will be responsible for contributing to the growth and success of HealthTexas while upholding our Mission, Vision and Values.

Culture and Values Expectations

At HealthTexas, we believe that our workplace culture is the cornerstone of our success. We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential. Our culture is the driving force behind our mission “to deliver quality and compassionate care with outstanding service, every patient, every time”. As a Medical Management Coordinator at HealthTexas we expect you to embody and promote our Values and defined behavioral expectations.

• Integrity: Do the right thing, the right way, every time.
• Be honest and uphold commitments and responsibilities, earn the trust and respect of the team and those we serve, and maintain privacy and confidentiality.
• Compassion: Treat everyone with respect and dignity.
• Foster an environment of inclusivity and well-being, practice patience and empathy, and assume positive intent.
• Synergy: Collaborate to improve outcomes.
• Invite and explore new opportunities, promote effective communication and teamwork, take pride in yourself, your work and HealthTexas.
• Stewardship: Use resources responsibly and efficiently.
• Implement effective strategies to attain goals, achieve maximum productivity and results, and seek continuous knowledge and improvement.
  

Essential Job Duties & Responsibilities

• Establish and maintain professional rapport with providers, members and other team members.
• Attend departmental meetings.
• Participate in Medical Director Review meeting by discussing patients after telephonic contact.
• Review daily census and assist with follow up tasks as needed as needed.
• Outreach telephonically to patients after hospitalization to complete transitional case management.
• Schedule office visits for patients after hospitalization ensuring they are seen by Primary Care Provider (PCP) within 7-14 days.
• Outreach telephonically to patients who have had a recent Emergency Room visit and schedule a follow up appointment with PCP or APC within 7 days.
• Outreach telephonically to patients to provide education.
• Obtain hospital records on patients from various hospital portals and input into patients medical records
• Mail out information to patients and providers.
• Fax out information to providers.
• Communicate with PCP and specialists as needed.
• Obtain medical records from patient’s specialty visit and input into their medical records in ECW.
• Maintain accuracy of specific spreadsheets on a daily basis.
• Respond to Telephone Encounters in Medical System in a timely manner.
• Comply with all guidelines established by the Centers for Medicare and Medicaid (CMS), if applicable.
• Other duties assigned by the director and/or supervisor.
  
  
  

Experience

• Minimum of 1 year healthcare experience providing care to the managed care population.
• Experience with an Electronic Medical Record.
• Computer experience including Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level.
  
  
  

Education

• High school diploma or equivalent.
• Current Medical Assistant Certification preferred.
  
  
  

Knowledge, Skills & Abilities

• Knowledge of Medical Management concepts preferred.
• Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas.
• Excellent telephonic customer service skills a must.
• A self-starter who is successful with minimal supervision.
• Typing skills, at least 40 wpm.
  
  
  

Work Hours, Travel Requirements

• Monday – Friday, 8:00 a.m. – 5:00 p.m., and as needed to complete projects.
• Travel to medical offices may be necessary for the purpose of providing benefit education.
  
  
  

Working Conditions & Physical Requirements

• This job operates in an office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets and fax machines.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
  
  
  

Please note this job description is not designed to cover or contain a comprehensive list of activities, duties, or responsibilities that are required of the employee for this job. Job responsibilities, location, work hours, etc., may change at any time with or without notice.