Job Description

Care Management Support Specialist

Business Office · Care Management
Plantation, FL
Health Care
Full Time, Days
Weekly Schedule: Monday through Friday8 am to 5 pm
Bilingual: None
Bilingual Type: N/A
Posted 09/06/2018
Req # 2027
  • PRIMARY FUNCTION
    • The primary function of the Care Management Support Specialist is to provide clinical and organizational support to the care management team in their day to day activities involving population health management. This includes telephonic outreach to specialists, home health agencies, PPECs and therapy providers for consults and plans of care. In addition, the position requires the ability to identify specific documents, ascertain the appropriateness of the documents and upload to the electronic health record system. Responsibilities include management of Excel file error reports and the faxing, printing, and emailing of documents Additional responsibilities may include the utilization of care gaps reports to provide outreach to identified patients to close Healthcare Effectiveness Data and Information Set (HEDIS) gaps and communication with families regarding CMS enrollment.
       
  • ESSENTIAL FUNCTIONS OF THE JOB
    • This list may not include all of the duties that may be assigned.

    • Detailed review of specific items forwarded to Care Management.
    • Review of Care Management dashboard to assure that document uploaded by offices is appropriate for care management nursing review.
    • Routes of all items to the medical offices that were inappropriately routed to the Care Management Department.
    • Faxing of supporting documentation to specialists, and agencies to obtain medical records that require review of specific plans of care.
    • Support the Care Management Team in the utilization of the Population Health Management System.
    • Facilitate the tracking of documents that were referred by the Care Managers though phone calls and providing appropriate follow-up and documentation in the SharePoint system.
    • Utilize SharePoint software for communicating follow-up and resolution to tasks as delegated by Care Managers.
    • Schedule appointments for future visits for PCP follow-up visits as required by the Medicaid guidelines.
    • The utilization of Excel reports to identify potential patient care gaps and provide outreach to these patients and their caretakers to close HEDIS gaps.
    • Scheduling appointments for future visits for HEDIS gap closure.
    • Educate and provide contact information to HEDIS gap patients of their specific health plan transportation, dental, behavioral health and vision vendor.
    • Reconciliation of immunizations in the electronic health record, Florida Shots and the gap reports.
    • Provides telephonic outreach to potential CMS patients that Patient Outreach Coordinators have identified as unable to contact.
    • Educating patients, parent and or guardian regarding the benefits of the practice including after-hours, availability of multiple locations, on-call triage and telemedicine.
    • Documentation of all interventions and activities in the appropriate location as completed.
    • Attendance and participation in all assigned provider office meetings and department meetings as scheduled.
    • Utilizing appropriate customer service skills in all encounters with patients, parent and/or guardians, professional contacts and employees.
    • Maintaining open communication with their supervisor, fellow team members and the management team.
    • Being knowledgeable of and following the policies and procedures of the department, the organization as well as governmental laws for confidentiality, HIPAA compliance and regulatory agencies, such as OSHA.
    • Meeting the performance goals and duties of the position.
    • Other various duties as assigned.
    •  
  • PERFORMANCE REQUIREMENTS
    • Education:
      • High School Diploma or equivalent with graduation from an accredited Medical Assistant Program.

    • Licensure:
      • Registered or Certification as a Medical Assistant

    • Knowledge, Skills & Abilities:
      • To qualify for this position the candidate must be a Medical Assistant that is detail oriented with good clinical and communication skills. Knowledge regarding HEDIS measures and population health management is a plus. Candidate must be knowledgeable in Microsoft Outlook, Excel, and Word. They must have a basic knowledge in medical terminology, and immunization requirements for children and adolescents.

        This position requires strong computer skill and experience with electronic health records. The candidate must have the ability to work independently and as a team. They must be detail oriented, have the ability to multi-tasks, possess excellent organizational skills and display exceptional customer service skills. They must possess strong telephonic skills and verbal articulation skills. The candidate must have the ability to assess emergency situations and act accordingly. Effective working relationships with patients, parents, guardians, fellow employees and the public are to be maintained.


    • Experience:
      • Prefer one to three years work experience in a clinical setting

    • Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.
COMPANY OVERVIEW: Founded in 1955, Pediatric Associates is one of the oldest and most respected pediatric practices in the United States. Pediatric Associates opened its first office in Hollywood, Florida. The Company was one of the first medical groups to introduce satellite office locations in consumer retail locations. They were also one of the first pediatric groups to embrace managed care in the 1970s, collaborating with insurance plans as healthcare partners with the common interest of providing South Florida's children with the best healthcare available. Today, Pediatric Associates is a national leader in pediatric population health management with over 200,000 patients under global risk. Keeping abreast of medical advances and changing lifestyles, Pediatric Associate’s modern facilities offer comprehensive services, including X-ray and state certified laboratories. The Company currently has 33 neighborhood locations, which are staffed by more than 200 employed providers who proudly serve families throughout Miami-Dade, Broward, Palm Beach, St. Lucie, counties, including Tampa and Jacksonville. Pediatric Associates will continue to bring the best possible healthcare service to its patients well into the 21st Century. Ease of access, prompt courteous service and responsiveness to our patients' concerns will always be their primary goal. Pediatric Associates has continued to thrive and today is recognized as one of the premier general pediatric and population health management practices in the United States.

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