Description

Job Summary:

Identify, track and contact patients for the purpose of achieving out reach program goals and achievements associated with improving the quality of care. Maintain records, statistics and data bases associated with local, regional program goals and regulatory requirements. Under the direction of and in collaboration with other healthcare professionals assist patients in identifying and using resources that improve quality of care.

Essential Responsibilities:

• Makes members/patients and their needs a primary focus of ones actions; develops and sustains productive member/patient relationships. Actively seeks information to understand member/patient circumstances, problems, expectations, and needs.
• Using established measures and criteria to identify patients within specific care programs, explains the need and answers questions related to specific programs, testing and outreach. Reviews patient medical record; and/or computer data to determine the need for further follow up and relays information to patient.
• Coordinates with care team at assigned clinic, collects data and maintains program databases and reporting. Tracking patient populations to obtain statistical information related to specific program goals associated with health care management and assure that patient records are updated.
• Reviews and identifies pertinent medical information in patient records; and other source documents; collects and applies codes as needed. Enters the appropriate codes for patient diagnosis, treatment, test result, or activities in the program tracking files, and chart.
• Verifies database information entered for errors and reports any issues or concerns through appropriate escalation pathway.
• Using established formats, develops letters, forms and other media required to educate and retrieve information from patients associated with specific care programs.
• Contact patients by phone and correspondence as pertaining to plan of care.
• Performs audits and compiles data for reports, program evaluation and QA activities and compliance.
• Supports care team by generating annual screening, utilization, compliance and other reports associated with care management programs and program performance.
• Processes internal and external medical referrals, reviews referral for completeness and requests additional information as necessary, functions as a liaison, and works independently; verifies member eligibility, ensures appropriate nurse assistance, enters information in the system; and outreaches members for scheduling and approvals as needed; responds quickly to meet member/patient needs and resolves problems. Manages external referrals and data for processing.
• Informs patients and providers of referral process and limitations, associated charges, appointments, and member responsibilities. Answers questions concerning eligibility, benefit coverage, referral policies and procedures, coordination of benefits and contracts.
• Perform other related duties as may be assigned.

Basic Qualifications:

Experience

• Minimum two (2) years of experience in a medical office or other patient care facility involving direct communication with patients regarding assessment of clinical needs. Some of this experience must have been of a very independent nature, such as (for example), experience: with limited on - site supervision; lead or project lead accountabilities; or significant self-directed accountabilities.
• Minimum two (2) years of work experience with administrative and technical duties to include strong computer skills and ability to learn advanced software programs and reporting of data related to disease management studies for inpatient and outpatient services.

Education

• High School graduation or equivalent.

License, Certification, Registration

• N/A

Additional Requirements:

• Ability to learn the use of computers for appointment scheduling and maintenance of the screening database and tracking system.
• Ability to orient patients to specific program, review medical history to determine the type of visit(s) necessary and follow-up with patient regarding screening/diagnostic needs.
• Knowledge of the procedures in maintaining and researching confidential information and the importance of medical data.
• Must be detail-oriented; able to work independently; plan, organize, prepare and determine priorities of daily tasks and responsibilities.
• Ability to communicate with staff and members in a caring and courteous manner.
• Effective verbal and written communication skills required.
• Completion of a medical terminology course and basic Word training (or equivalent experience) is required.
• Typing speed of 35 wpm required.
• Experience authorizing /denying referral requests.
• Demonstrated ability to read/interpret provider orders.

Preferred Qualifications:

• Three or more years experience working in an integrated care delivery system preferred.
• Associates degree in a Healthcare field preferred.
• LPN or MA license preferred.

Primary Location: Colorado,Denver,Regional Office - Colorado
Scheduled Weekly Hours: 1
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Call-in/On-Call
Job Type: Standard Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: C01|SEIU|Local 105
Job Level: Individual Contributor
Department: Waterpark I - Population Mgmnt-Other Progs - 1608
Pay Range: $29.78 - $40.56 / hour Travel: No Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information.
Requisition #: 1393476

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