Job Summary:

The Care Coordinator - Massachusetts at CareSource/Commonwealth Care Alliance is the primary point of contact for a stratified panel of members whose role is to assist enrollees in navigating their health care providing care planning and coordination of services, ensuring timely service delivery and prompting continuity of care through coordinated outreach and engagement with members and providers. This role is responsible for routine enrollee outreach, including community-based visits, telephonic or virtual visits, documenting service activities, and supporting administrative functions that enhance member satisfaction.

Essential Functions:

• Serve as the first point of contact for enrollees, including assisting enrollees with understanding health plan processes, appeals and grievances and assist with removing barriers to getting needed services
• Conducts routine outreach to members and providers to confirm service details, coordinates services with long term services and supports teams, , serves as a health plan subject matter expert and accurately documents care coordination activities.
• Provides in-person visits to enrollees at least annually, with member consent
• Maintain open lines of communication with enrollees, as needed based on Enrollee preferences
• Maintains accurate and timely documentation and internal systems to ensure visibility across teams and continuity of service.
• Coordinates provider and member scheduling efforts, supports high-volume outreach campaigns, and ensures task completion across multiple systems
• Identify potential social support or community-based needs
• Lead the interdisciplinary care team (ICT) for a stratified panel of members, collaborating with team members internal and external to the organization to create an enrollee centered care plan
• Provide education on plan benefits and service options
• Serves as a support resource for enrollees and providers, and escalate concerns by coordinating responses and ensuring issues are routed or addressed promptly
• Collaborates with clinical care managers, behavioral health clinicians, community health workers, providers, and external partners as needed to ensure smooth communication and continuity across care activities
• Gather and document service-related information during members interaction to support care coordination, service planning, or referral processes
• Maintain accurate documentation and maintenance of the centralized enrollee records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners as needed
• Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements
• Ensure enrollees follow up with providers, including assistance with appointment scheduling and verification of transportation
• Facilitate communication and information exchange with the member and their providers and community supports
• Performs any other job related duties as requested.

Education and Experience:

• High School or GED required
• Two (2) years of experience in healthcare, customer service or a related industry required

Competencies, Knowledge and Skills:

• Basic proficiency with Microsoft Office Suite to include Outlook, Word and Excel
• Knowledge of Medicaid, Medicare and Managed Care is preferred
• Customer service focus with exceptional listening, written and verbal communication skills
• Displays professional phone etiquette
• Ability to multitask using a variety of computer applications
• Strong organizational skills
• Effective problem solving skills with attention to detail
• Ability to work independently and within a team environment
• Understanding and supportive of managed care concept
• Adaptable to a constantly changing environment
• Able to type (document) and talk (telephonically) simultaneously

Licensure and Certification:

• Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential.
  Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
  Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need
  May be required to travel greater than 50% of time to perform work duties.
  Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer
  Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members
  
• Over 50% (Mobile) Routine travel required

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.