Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

The Care Management Care Coordinator functions as an integral part of the Care Management department. They are a member of a team that supports the day-today functions of a complex medical network and activities include, but not limited to, outreach functions, assignment of care management cases, mailbox communication and referrals, other. This individual must be able to plan, organize, and prioritize work to ensure completion in a timely manner. He/she functions as a key contact and department representative both to internal and external customers of the care management department through verbal and written communications.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

Support the General Case Management Process within Case Management Department:
- Initiates outreach cycle and documents in electronic record and/or member referral status.
- Accurately identifies when to escalate issues which may prevent meeting department timelines for completion of notification to providers for denials and for requests for information.
- Track, manage and triage member needs within the defined intervention period for the member specific population, complete follow-up responsibilities within required timeframe.
- Provide education and coaching to the member, family, and/or caregiver about follow up care and health status, goals of transition care, and health insurance benefits to assist members in making the most informed decisions and to promote self-management of care!
- Ensure timeliness in coordination of health care services. Assist members with scheduling appointments, tests, screenings, and transportation.
- Assist execution of special projects and outreach campaigns
- Communicate with outside stakeholders and vendors appropriately to coordinate member care as needed.
Performs general office duties:
Accurately enter data into MedHok, Casetrakker and/or Jiva, and other databases and tracking programs
Complete clerical and Right Fax tasks as required.
Effectively prioritize tasks and ensure deadlines are met.
Employ multi-tasking skills when multiple deliverables are due.
- Employ multi-tasking skills when multiple deliverables are due.
Accurately identifies any issues to escalate to a Team Leader
Support Clinical Initiatives and Programs:                                   
Supports the development and implementation of programs related to quality measures.
Participate in outbound calling programs to members with potential quality triggers.
Provides departmental process support in duties unique to assigned service operations area.
Attends scheduled meetings and assigned training sessions.
Other projects and duties as assigned.

Qualifications – What You Need To Perform The Job

Certification and Licensure

Education

Required (minimum): High School degree.
Preferred: Associate’s degree in business and/or related administrative or clinical field is highly desirable.

Experience

Required (minimum): 3-5 years’ experience in a professional environment.
Preferred: Experience in a health care environment, especially in managed care is highly desirable

For internal applicants, experience is required in) Casetrakker, JIVA or the MedHok platform. External applicants must demonstrate potential to become proficient in Casetrakker, JIVA or the MedHok platform within 3 months of training.

Skill Requirements

Strong knowledge of Clinical Services’ departments and Point32Health organizations in order to assess situations and direct internal and external customers appropriately accurately and quickly.
Strong computer skills with proficiency required in Microsoft Word, Excel, in an e-mail program and the Intranet. Experience in Power Point, Access, Visio, and other software applications desirable.
Work independently and cooperatively as a team member across multiple levels within the organization
Must have a commitment to excellence in customer service.
Must have well developed written and verbal communication skills.
Ability to identify emergency situations and follow the established protocol.
Ability to handle multiple demands and must be able to balance multiple priorities within set protocols and procedures.
Strong organizational skills to be able to handle a routine workload and multiple tasks while maintaining excellent customer service.
Ability to increase workload and be flexible with coverage responsibilities to meet strict department deadlines.
Must be able to exercise sound judgement as necessary and to work and communicate with customers in a telephonic office and remote environment.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

Must be able to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May be required to work additional hours beyond the standard work schedule.
Fast paced office environment handling multiple demands independently.
Must be able to exercise sound judgment as necessary and to work and communicate with customers in a telephonic office and remote environment.
A cubicle-based hoteling and remote work environment, which presents challenges to maintaining focus on the work while exposed to other voices and work sounds.
Ability to enter data and type the information received during a telephone conversation.
Ability to carry 5 – 25 pounds of materials from one business area to another, approximately a distance of 100 yards.
Digital and manual dexterity required for keyboard along with ability to work on a display monitor for long periods of time.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$23.47 -$35.21

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all

All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org

Point32Health

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