Care Coordinator RHP

Spartanburg Regional Healthcare System

Job Description

Position Summary

As a care coordinator, you will processes the initial setup of members in the system, enrolling and conducting orientation; review and collect data for all new members ensuring thorough data is populated in the system. Interact with and manage low to moderate risk members (referring high-risk to Complex Case Management team) through data collection, and interaction with the members. Must meet productivity standards; complete work in a timely manner. Must be flexible and adapt to changes in the work environment; manage competing demands; change the approach or method to best fit the situation; be able to cope with delay or unexpected events. Take responsibility; keep commitments; complete tasks on time. Volunteer readily; take independent actions; ask for and offer help when needed.

Core Job Responsibilities

Identify, enroll, refer, and orient new members into various CarePlus programs including but not limited to precerts, disease management, condition management, etc.
Interact with members by phone and/or face to face; may be required to meet member in various health care settings, such as; physician offices, hospital and the patients home.
Identify opportunities for member intervention, in order to promote compliance and improve clinical outcomes by contacting the members, assisting with appointments, closing care gaps, retrieving missing documentation, and basic life needs, etc.
Be responsible for receiving incoming calls, faxes, and emails for the department and processing intake as necessary.
Must meet productivity standards, daily, weekly and monthly.
Professionally resolve member/customer requests and concerns.
Provide outreach to engage members to assess their readiness to change by using motivational interviewing techniques to help members identify and overcome barriers and then refer to the appropriate source.
Proactively collaborate with providers, community resources, and other colleagues to help members achieve the best possible outcomes.
Provide information regarding the appeal and authorization process to members, physicians, and mid-levels including Miliman and/or National criteria for appropriateness, as requested.
Contact 3rd party administrators for retro-authorizations, claims issues, appeals, and provide 3rd party administrator with updates on reviewed appeal, as needed.
Obtain clinical/case management for utilization review, high risk case management review, as directed by supervisor.
Proactively collaborate with providers, community resources, and other colleagues to help members achieve the best possible outcomes.
Participate in team meetings and regular training sessions.
Be able to collect, provide, defend data and goals of any CarePlus program.
Seek ways to improve and promote quality healthcare.
Properly handles member records to ensure compliance with patient health information applicable to the preservation, accuracy, and completeness of communication and/or retention of patient information, meeting all HIPAA regulations and the HITECH Act provisions as required by law
Serves as a back up to other Care Coordinators.
Achieves population health improvement and goals.
Minimum Requirements


HS Diploma, 2 year degree preferred
Experience Prior experience working as a Medical Assistant and/or Medical Front desk interacting with patients
Required Licenses/Registrations/Certifications

Must maintain a valid US Driver's License and good driving record.

Employment Type