Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a Centralized Case Management Coordinator l in Anaheim, CA.
Case Management Coordinator (CMC I) plays a vital role in supporting the coordination of care for patients, ensuring they receive necessary services and resources. This position primarily involves administrative tasks and communication with healthcare professionals, patients, and other stakeholders. Perform centralized case management duties and responsibilities such as follow-up care of primary care and reproductive care, assistance with medical records, faxes, and referrals in accordance with Planned Parenthood and health plan regulations. Serve as liaison between PPOSBC and outside providers, external lab, follow-up with consultation of specialty care, and continued plan of care from consulting providers. Manage and track ongoing communication for patients' continued care that has been referred to specialty providers. Provides coverage and assistance to other members of the case management team and Patient Services Department.
At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family. We are proud to offer a range of plans that help protect you in the case of illness or injury including:
A competitive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability.
Benefits coverage starts after one full month of employment!
Generous vacation, sick, and holiday benefits!
Generous 401(k) matching contributions and more!
To view our detailed benefits guide, please visit our career site at www.pposbccareers.org
Responsibilities
Essential Functions: Essential functions encompass the required tasks, duties, and responsibilities performed as part of the job and the reason the job exists.
Provides standardization of centralized patient case management of the referral process due to beyond the scope of practice of PPOSBC according to PPFA and PPOSBC medical protocol guidelines with a focus referred patients. Ensure compliance with PPFA protocols for referrals.
Submit, process, and manage referrals and prior authorizations, including expediting the referral and prior authorization process for high-risk cases and reviewing and scanning records of evaluations done outside the affiliate.
Complete assigned case management responsibilities and duties to ensure appropriate patient care related to primary care, family planning, and abortion care.
Act as a patient advocate by identifying and addressing barriers to accessing appropriate services. Assist patients in problem solving potential issues related to the health care system, financial or social barriers and providing appropriate resources and options to patients.
Process incoming faxes, medical records, and other patient documents to meet health plan compliance guidelines and expectations.
Maintain communication with the outside facilities, health plans, and external laboratory for problem solving relating patient follow up and quality care.
Collaborate with Clinicians/Providers as needed to ensure quality care regarding patient follow-up – including but not limited to scheduling appointments and coordinating outside referrals and outcomes.
Keep Clinician/Supervisor apprised of any problems, incidents or potential problems involving patients or staff as relates to any services.
Collaborate with Call Center department to efficiently respond to non-medical patient calls and address patient questions or concerns with respect and empathy.
Schedule appointments and screen as needed for family planning/primary care including but not limited to contraceptives and abortion services as needed.
Cross-train in additional case management tasks and provide coverage and assistance to other members of the case management team as needed.
Assist with processing incoming prescription refill requests in a timely manner, in accordance with PPFA and PPOSBC medical protocol guidelines and standing orders.
Answer non-medical triage calls during business hours.
Work in collaboration with Case Management and Health Center staff on high-priority patient cases, including but not limited to primary care complex care management.
Assist with informing patients of lab results and coordinating follow-up care as needed
Provide disease-specific patient education within scope of practice as directed by the clinical staff.
Review Case Management Call Back patient schedule daily and complete all scheduled patient appointments as required per medical protocol guidelines
Non-Essential Functions:
Other duties as assigned.
PHYSICAL REQUIREMENTS:
The physical requirements of this position are identified below. Reasonable accommodations may be made for individuals with disabilities to perform the essential functions of this position.
CORE COMPETENCIES – WE CARE:
Welcoming: Anticipates customer requirements and gives high priority to customer satisfaction and service. Handles problems quickly and efficiently. Maintains a pleasant, positive and professional approach. Embraces opportunities to help team members, stakeholders, and other departments.
Equitable: Creating equitable access and opportunity for all through education, practicing inclusive behavior, elevating others’ voices, creating spaces for honest conversation, and listening without judgment. Values and uplifts our collective diversity within in our agency.
Confidential: Respects the information shared by our patients, employees, and vendors and maintains appropriate confidentiality. Follows all policies and laws that protect private & privileged information.
Accessible: Is available and approachable to others, open-minded, fair and non-defensive. Appreciates constructive feedback and is a team player. Demonstrates good listening skills.
Respectful: Values diversity and treats everyone with dignity and courtesy. Dependable and courteous of other people’s time and commitments.
Empathetic: Demonstrates interest and understanding in other people’s feelings, attitudes and reasoning. Maintains an open and non-judgmental demeanor that is patient, flexible, and understanding.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Education:
High school diploma or equivalent experience required; additional education or training in healthcare administration or related field preferred.
Medical Assistant certificate from accredited organization is preferred.
Minimum Work Experience:
One or more years of clinical experience, including case management, primary care, reproductive care, and women’s health is preferred.
One year of administration experience.
Previous work experience with processing referrals through various health plans is preferred.
Other Requirements:
Ability to work independently and be team-oriented.
Ability to work under standardized protocols and procedures.
Excellent interpersonal, problem solving and communication skills.
Ability to work as part of a team of people with diverse knowledge and backgrounds.
Ability to be diplomatic.
Needs to be self-motivated and self-directed.
Proficient in Microsoft Office and EMR.
Proficient in navigating health plan portals and prior authorization systems.
Effective verbal and written communication skills.
Ability to adapt to new implementations and processes to meet the demand of patient care.
Proven analytical and strategic thinking skills, accuracy, and attention to detail essential.
Availability to work flexible hours, including weekends, as required.
Assist in the coordination of care for patients, including scheduling appointments, benefits navigation, and coordinating support services.
Communicate with healthcare providers, and insurance companies to ensure seamless delivery of care.
Maintain accurate and up-to-date patient records, including documenting interactions, appointments, and care plans.
Provide support to patients and their identified care persons by answering questions, providing information about available resources, and offering assistance as needed.
Collaborate with other members of the care team to identify and address any barriers to care or additional support needed for patients.
Participate in team meetings and projects to discuss patient progress, updates, and any changes to workflows.
Adhere to all relevant policies, procedures, and regulations governing patient care and confidentiality.
Strong commitment to quality healthcare and excellent customer service.
Ability to demonstrate mature judgment, initiative, and critical thinking.
Excellent written and verbal communication skills.
Accuracy and attention to detail essential.
Demonstrated proficiency in use of EMR (electronic medical record).
Maintain professional demeanor at all times.
Have valid CA driver’s license and a reliable means of transportation.
Agency Standard Requirements:
Strong commitment to quality healthcare and excellent customer service is required.
Must thrive in a fast-paced, rigorous environment with changing priorities.
Ability to meet deadlines and work under pressure.
Must demonstrate high-level computer skills, including Microsoft Word, Excel, and Outlook. Electronic medical records experience may also be required.
This position requires travel to other sites and locations; if using a personal vehicle to meet this requirement, a valid CA driver’s license and current auto insurance in compliance with the minimum requirements of CA vehicle code are required
Abortion patients are cared for at each of our health centers and in part through the administrative, support, and other non-clinical services provided at all PPOSBC locations and by all PPOSBC employees, and supporting these critical services is an essential job duty and fundamental responsibility of all employees.
