Duties
Responsibilities Include, But Are Not Limited To
"As part of the care coordination team, the Resource Coordinator supports the development of and executes on the outreach strategy in a certain territory for the purposes of influencing health outcomes and member engagement. This position is responsible for establishing and cultivating relationships with members, community stakeholders and providers.
Actively assisting providers in discharge planning for Level 1 members following acute episodes of care involving at a minimum one of the following services: inpatient psychiatric stay, ambulatory surgery, hospital inpatient stay, and rehabilitation facility services.
- Assistance shall include but not be limited to: appointment setting, referrals and linkages to services, coordination of DME, and coordination of prior authorizations as needed to support the member's timely access to services in the community
Assist in closing social determinants of health and care gaps through appointment assistance, coordinating transportation, connection to community resources and wellness programs
Establishes connection and acts as the primary ACFC contact to a targeted member population through home visits, community visits and outreach calls.
Exercises judgment and discretion in the coordination of care by handling basic care follow up tasks and collaborating with AmeriHealth Caritas care coordination teams, community based health care providers, and other organizations.
Informs members of the required actions to fulfill HEDIS, EPSDT, and Plan requirements and other referred outreach, through phone calls or home visits, and encourages them to comply.
Assists in addressing members' barriers to care and to encourage/foster relationships with their medical/dental providers (medical/dental homes). "
Skills
Community based care experience preferred.
Behavioral Health Experience Preferred.
Previous experience in presenting health education materials to individuals and small groups
Knowledge and understanding of medical terminology and disease processes
Ability to effectively communicate preventive health and health management philosophies to member's and agencies
Comprehensive knowledge of Medicaid requirements and plan, policies and procedures.
Knowledge of managed care.
Up to 50% of time will be spent traveling Candidate must possess a valid driver's license and be willing and able to drive a car "
Education
Associate's Degree in Health Care, Human Services or a related field or equivalent work experience. Bachelor's Degree
