We’re unique. You should be, too.
We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?
We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.
ESSENTIAL JOB FUNCTIONS:
The Care Coordinator will work with Care Center of Excellence, Physician Management Resources (PMR), market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management in ChenMed Medical Centers.
Primary Duties and Responsibilities
- Daily review of approved and pended outpatient requests for PMR clients and ChenMed Markets.
- Provide insights to the PMR team and Network Director and work with them to take action.
- Facilitate a daily process to help redirect poorly supported requests by:
- Providing feedback to Humana, Careplus, Wellcare and Coventry and working through daily authorization requests when information is missing.
- Create process for managing requests when patients need to see the primary care provider by coordinating with primary care provider and Market leaders.
- Enable a member of PMR network or clinical team to reach out to authorization requester when deemed necessary.
Other responsibilities may include:
- Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible one dependent on market needs.
- Travel as needed to PMR & ChenMed markets for training and support.
KNOWLEDGE, SKILLS AND ABILITIES:
- Excellent analytical skills in order to solve the complex and logistical problems.
- Strong communication and interpersonal skills, both written and verbal, as well as delivery skills for presentations and training.
- Excellent organizational skills with ability to effectively manage multiple tasks and responsibilities.
- Ability to deliver efficient, high quality results within tight deadlines.
- Works well independently and within a team.
- Excellent influencing and negotiation skills.
- Ability to explain complicated financial terms and utilization data to physicians/staff.
- Ability to understand, interpret and communicate all types of provider, regulatory contracts and utilization management data.
- Fluent in English.
EDUCATION / SPECIALIZED KNOWLEDGE REQUIREMENTS:
- Bachelor's degree.
- 3+ years Utilization Management and/or Provider Relations or Healthcare Analyst experience or similar background.
- Advanced MS Word and Excel.
- The ability to establish credibility quickly and the willingness to take a strong approach to leadership.
- An understanding of the communities that ChenMed and PMR serves, including the complexities of Medicare programs to patients in the current healthcare marketplace.
EDUCATION AND EXPERIENCE CRITERIA:
- High School diploma or equivalent required.
- Up to one (1) year of relevant work experience required. Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred. Healthcare experience in a clinical setting, preferably within the Medicare HMO population is a plus.
- CPR for Healthcare Providers is preferred. A valid driver's license in State of employment is required; position may require travel within the market.
We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care.
ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day.
Current Employee apply HERE
Current Contingent Worker please see job aid HERE to apply
Top Skills
What We Do
ChenMed brings concierge-style medicine and better health outcomes to the neediest populations – moderate-to-low income seniors with complex chronic diseases. Operating over 50 medical centers in eight states, we are known to our patients as Dedicated Senior Medical Center, Chen Senior Medical Center, or JenCare Senior Medical Center.
Through our innovative operating model, physician-led culture and empowering technology, we drive key quality and cost outcomes that create value for patients, physicians and the overall health system. By recruiting focused physicians and reducing their doctor-to-patient ratios, we increase patients’ “face time” during each monthly appointment and help foster stronger doctor-patient relationships.
Results of our high-touch approach to primary care are impressive, as illustrated in the recent Modern Healthcare cover story published on Oct. 20, 2018, which reports that: “Indeed, ChenMed's approach has resulted in 50 percent fewer hospital admissions compared with a standard primary-care practice, 28 percent lower per-member costs, and significantly higher use of evidence-based medications.”
