Care Coordinator

The Care Coordinator is responsible for receiving, processing, and coordinating all new patient referrals for NorthCoast who require home health, home infusion, or hospice services and coordinates care of patients. Works closely and collaboratively with facility discharge planners, physician offices, Health Plans, network provider organizations, and patient/family to initiate an appropriate and timely start of care for the home care patient.

Responsibilities

• Uphold the mission, vision, and values of NorthCoast Heath Care Management Inc.
• Exercises confidentiality and protects the privacy for the greater good of the company.
• Adheres to NorthCoast professional behavior standards
• Adheres to established attendance schedule
• Performs other departmental, interdepartmental, and organizational duties/tasks as needed and requested

OPERATIONS:

• Communicates (phone, fax, email), collaborates, and plans with discharge planner, physician office, and/or network provider in referral/intake process for appropriate discharge and initiation of patient’s home care program.
• Applies Health Plan benefit, patient clinical need and home care support with physician order to development of home care services. 
• Receives referrals from referral sources and coordinates, authorizations, precertification, predeterminations for the patient. 
• Secures pre-certifications, pre-determinations, and authorizations from health plan.
• Research and processes appropriate diagnostic codes for intake and patient services.
• Arranges provider of service based on patient clinical need and geographic location.
• Coordinates and arranges appropriate home care providers and start of care.
• Arranges services/products/pharmaceuticals in accordance with member health plan benefits, clinical need, and physician orders from start of care through discharge in a timely manner.
• Applies knowledge of in-home care polices/procedures and Medicare guidelines to health plan patients
• Troubleshoots and resolves problems/concerns relative to services with patients, providers, pharmacies, health plan
• Assists with billing issues to seek resolution relative to patient services authorized and provided
• Maintains open lines of communication with all customers (internal and external) to facilitate best plan of care and outcomes for homecare patients.
• Advocates for the patient regarding best use/most appropriate service relative to health plan benefit.
• Secures/reviews patient care documents in a timely manner and as is necessary for coordination of services (documents include:  assessments, disciplines of care updates, health plan authorizations, denials, discharge summaries, Advantage Plan-OASIS/NOMNC).
• Assists provider with discharge planning as appropriate for the patient and in accordance with visit/financial limitation of health plan benefit.
• Troubleshoots and assists in resolution of any start of care issues/concerns.
• Participates in collection and reporting of quality issues/concerns to direct leader.
• Possesses knowledge of payer and provider contracts related to pricing and contract terms.
• Participates in the on-call schedule. 
• Assists in orientation of new staff.

 REGULATORY COMPLIANCE:

• Protects all medical information under HIPAA privacy for PHI and HIPAA security for EPHI
• Adheres to Corporate Compliance Plan related to fraud, waste, and abuse
• Adheres to Code of Ethics and Business Conduct Plan
• Abides by organizational policies and procedures regarding business and medical data
• Adheres to identity theft prevention program, “red flags” policy
• Acknowledges awareness of provider/personnel potential non-compliance to regulatory provisions is reportable to management

PERFORMANCE STANDARDS:

• Sets high standards and goals for self, role, and performance
• Demonstrates pride in work team, and organization as a whole
• Completes work on schedule; sets and meets expected timelines
• Remains aware of personal and team needs, short term and long-term objectives
• Supports and encourages colleagues in their performance
• Shows initiative, reliability, follow through and the ability to self-monitor workload and performance

CUSTOMER EXPERIENCE:

• Gives highest priority to creating exceptional customer experience
• Anticipates and honors customer request, needs and issues with timely follow through
• Handles and addresses customer complaints/ concerns in empathic pleasant manner
• Demonstrates ability to remain calm under pressure and resourceful under challenging and tension filled situations
• Exudes results-oriented, friendly, and positive minded attitude and manner to internal and external customers

COMMUNICATION

• Demonstrates ability to communicate effectively and express ideas clearly and concisely
• Communicates in a respectful, helpful, and positive manner with colleagues demonstrating a teaming philosophy
• Follows appropriate organization lines and protocol addressing concerns, issues and questions while suggesting ideas for operation and relational problems

Education

Qualifications

• Strong interpersonal skills
• Highly resourceful team-player, with the ability to also be extremely effectively independently
• Knowledgeable of standard Microsoft office programs and ICD10/HCPCS coding.

• 5 years’ experience in home health, hospice and/or home infusion therapy

Benefits

• Medical
• Dental
• Vision
• Disability Insurance
• Life Insurance
• Paid Time Off after 90 Days
• 401(k)
• 401(k) matching

Schedule

• 8-hour shift
• Monday to Friday

Work Location

Work Remotely