Enhanced Care Management Advocate I

KHS reasonably expects to pay starting compensation for the position of Enhanced Care Management Advocate Bilingual I in the range of $23.13 – $30.14 hourly.   Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.Job Summary   This position reports to the Enhanced Care Management Supervisor.  The Advocate will support their assigned ECM Program Site in the distribution of incentives and support with oversight of various reports to ensure the care management staff are kept up to date on all enrolled members activities whether it be appointments, reconciliation of encounters to claim, hospitalizations, ER and UC use and discharges. This position will provide care incentive distribution and oversight of program reports and requirements at the site level.   Essential Duties and Responsibilities:   Distribution of incentives to qualified enrolled members per incentive guidelines for active participation in the ECM. Ordering and tracking of incentives including daily reconciliation of gift cards. Reconciliation of ECM services (Electronic Medical Records (EMR) to claims submission). Any discrepancy will be brought the site management attention and corrected before claims are submitted to KHS, the reconciliation will be done within 24 hours of a patient being seen. Will evaluate KHS reports and collaborate with ECM site to identify and resolve missing claims and other ECM requirements Review member aging report and collaborate with site staff to contact members not served within identified time frame Review daily inpatient report and make sure the site has a care coordinator assigned to members in hospital for contact and transfer of care (TOC). Complete enrollment reconciliation between site and KHS records, including routine monitoring and site provided census reports Perform outreach to eligible members and engage enrolled members to determine unmet needs and program satisfaction Review discharge reports to ensure assigned care coordinators are aware of discharges so they can contact member for TOC appointment within 48 hours of discharge. Review ER, UC and Nurse Line reports and alert CC or CM of member calls for follow up. Eligible members on Nurse line report to be contacted by site staff or ECMA for initial appointment. Monitor individualized care plan completion within identified time frame, associated member follow up documentation and care plan revision Monitor members authorization end date and collaborate with site for reassessment Knowledge of the healthcare industry and familiarity with managed care plan designs and benefits Knowledge of the history, development and business case for the patient centered medical home model Proficient in the use of multiple applications such as Microsoft Office Possesses excellent written and verbal communication with contract providers and internal KHS staff to promote effective and timely coordination of care and dissemination of KHS policies and procedures. A willingness to work effectively in a team Collate, track and share data with the provider from the plan level Provide member resources such as customer service related to the ECM Willingness to work at the assigned ECM site locations. Responsible for maintaining assigned case load and member contacts as required by the program protocols Keeps accurate, up-to-date documentation on members served in the program Advocate for members when there is a problem in the service delivery system Monitor all internal reports and work closely with the site to ensure that all required program protocols are being completed on a timely manner. Assists management staff in completing member services related special projects. Organizes and maintains departmental files, records Utilizes computer for detailed data entry Completes calls related to patient satisfaction as directed by management Engages in activities related to other clinical services initiates Good Writing and Verbal skills are essential  Employment Standards:   Education: Bachelor’s degree from an accredited institution or equivalent; or Medical Assistant (MA) Certificate, or 3 years of Case Management experience in the Health Care field required.   Experience: Three (3) or more years of recent experience in a direct healthcare service-related field with a high degree of problem solving and decision making. Strong telephone and communication skills required.  Patient centered medical home experience preferred.   ** Bilingual Spanish/English (Tier I) Certification preferred. Travel 20%   Certifications: Current BLS/CPR certification  Site Location Health Requirements: TB Test Influenza (Vaccination) or Declination