Care coordinator

at MetroPlus Health Plan

Job Detail




3+ years minimum experience

Schedule Type

Full Time


160 Water St, New York, NY 10038, USA




08/22/2019, 05:27 PM


41610 In-Field Coordinator Job Description Provide educational support and training to physicians, staff, and pharmacists to ensure compliance with Clinical Practice guidelines, Preventive Health guidelines and quality improvement activities to improve the delivery of quality health care and service to address members. Monitor provider-specific HEDIS report cards. Identify areas of concern and address with office management and/or hospital contacts to initiate improvement. Monitor provider/facility progress on monthly basis; prepare and distribute monthly member gap in care reports and partner with onsite Medical Management staff to coordinate closure of gaps in care through: Outreach to address members by face-to-face encounters, telephonically and via other communication venues to provide education on how to access services, the importance of health maintenance, preventive health visits and maintaining a relationship with their PCP. Provide or arrange for health education for members with various diseases such as but not limited to Asthma, Diabetes, Hypertension, Hypercholesterolemia, Obesity and Heart Disease Focus to prevent readmission and/or utilizing the emergency room inappropriately. Schedule member appointments for preventive health visits as necessary via the hospital's scheduling system. Refer potential candidates to on-site facility health education programs or disease management collaborative, and/or set up appointments for address health education initiatives and/or other needed screenings/tests i.e. lab work, eye, dental exams, etc. Document all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards for address to ensure integrity of member services provided over the continuum of care and over time. Complete on-site provider visits and/or meetings with admin/claim management on a regular basis to conduct education sessions regarding appropriate coding practices and medical record documentation practices. Reviews site coding practices to look for improvement opportunities Maintain knowledge of medical record review and EMR systems. Facilitate retrieval of medical record documentation and work with provider group(s) to retrieve electronic data that supports HEDIS/QARR. Records findings of patient encounters to include patient identifiers, relevant information and results. May work with provider offices to facilitate request and review of charts in support of HEDIS & QARR annual. Other duties as assigned by Manager Minimum Qualifications Clinical background: Health Educator, RN, LPN, RN, LMSW or LCSW, Foreign Medical Graduate (FMG) with a minimum of three years relevant work experience. Bachelor’s Degree preferred. An equivalent combination of training, educational background and experience in related fields and educational disciplines. Experience with medical record review working on HEDIS/QARR in a managed care setting or health plan setting. Prior experience in Quality Improvement in a health care and/or Managed Care setting strongly preferred. Strong written and verbal presentation as well as data analysis skills required. Ability to proficiently read and interpret medical records required. Knowledge of HEDIS specifications required. Knowledge of ICD-10 and CPT codes preferred. Must know how to use Microsoft Office applications including Word, Excel, PowerPoint and Access. Ability to travel within the address service area Experience with relationship management. Ability to work in a team setting. Licensure and/or Certification Required Health Educator, RN, LPN, RN, LMSW or LCSW, Foreign Medical Graduate (FMG) Professional Competencies Integrity and Trust Customer Focus Functional/Technical skills Written/Oral Communication