Job Detail

The Outpatient Care Coordinator II will identify and reduce barriers to members’ care, assist the member in locating and accessing resources and educate the member on the importance of accessing care promptly. Serve as the primary point of contact with members and will be an integral part of the member’s interdisciplinary care (ICT) team, provide support to the member as they self-navigate the health care system, and work closely with member’s case management team to resolve access, medical and psychosocial related issues. Efficiently manage and prioritize assigned caseload while working with a licensed clinical professional (case manager) to ensure optimal coordination of care for the Health Plan members. This position will serve as a liaison between Health Plan members, Prospect, Primary Care Provider (PCP), specialists and other members of the health care team.

• Conducts telephonic outreach to members to discuss and offer Outpatient clinical programs.
• Oversee a caseload of basic members to manage and coordinate care according to members’ identified needs.
• Interact with assigned members telephonic and/or in-person as appropriate.
• Review of Health Risk Assessment and identify member’s coordination of care needs.
• Established member-friendly care goals with members.
• Coordinate care for members as appropriate such as scheduling appointments, creating authorizations to facilitate/expedite member’s requests, etc.
• Facilitates completion of quality measures through education and coordination.
• Timely processing of incoming referrals to Outpatient programs per set timeframes.
• Completes post-discharge calls for members per set timeframe. Determines additional post-discharge needs such as scheduling follow-up appointments, coordinating ordered DME and services, etc.
• Collaborates with the health plan, PCP, and health care team to ensure timely coordination of member’s needs.
• Facilitates warm transfers to member's assigned case manager in accordance with member needs, when appropriate.
• Completes post discharge calls for members per set timeframe. Determines additional post-discharge needs such as scheduling follow up appointments, coordinating ordered DME and services, etc.
• Identifies the need for, and facilitates, referrals to Long Term Support Services (LTSS), Behavioral Health, and other community resources.