The Care Management Coordinator will be responsible for the following:
- Independently processing referrals for care management including, but not limited to, medications, skilled and private duty nursing, infusion and enteral therapy services, durable medical equipment and supplies, Home Care Agencies: Early Intervention Program (EIP), Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP) and transportation throughout the care continuum.
- Review daily work assignments and prioritize to ensure critical requests are addressed.
- Collaborating and delivering clear, effective communication with multidisciplinary team members to coordinate identified care management activities within the assigned ambulatory/outpatient clinical setting.
- Serving as a liaison, working with licensed clinical providers within assigned areas to ensure regular, fluid communication with relevant clinical and non-clinical groups is ongoing by establishing connectivity between all sizes throughout the care continuum process.
- May serve as a point of contact for patients and family members as necessary, providing high services and support. Assist with status regarding urgent or emergent requests and other inquiries.
- Working with insurance companies to obtain prior authorization approvals. If needed, assist the clinical team in coordinating and pursuing the denial/appeal process. Planning and prioritizing the coordination and tracking of the prior authorization renewal process.
- Coordinating medication prescription requests, including but not limited to prior authorizations, verbal overrides, setting up specialty pharmacy accounts, verifying copays and exploring assistance options, referring to Social Work, or assisting with Free Care if needed.
- Coordinating extensive worklist of patient requests to ensure timely submission, approval, and follow-up of all requests. Working independently and using critical thinking skills to ensure requests are completed.
- Coordinating and participating in special projects as needed, including new team member orientation and training.
To qualify, you must have:- High School Diploma / GED required; Associate's Degree preferred
- Three years experience in Care Management required
- Intermediate skills in MS Office Excel, Outlook, and Word
- Ability to communicate effectively both orally and in writing.
Knowledge of medical terminology and experience with Electronic Medical Records is preferred. - Ability to work independently in a clinical setting
- Ability to use critical thinking skills to make independent choices supporting established administrative case management standards.
- Ability to identify, locate and effectively utilize resources, including databases, reference materials, and libraries, to obtain information
- Maintains a working knowledge of insurance plans.
Boston Children's Hospital offers competitive compensation and unmatched benefits, including flexible schedules, affordable health, vision, and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and specific License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork. |
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