The Program Coordinator works with relevant stakeholders to support the administration of the Special Kids Special Care program. The individual is responsible for working with the SKSC clinician team and serves as the primary liaison to various key BMCHP departments including Member Services, Public Partnerships, Utilization Management, Vendor Management, Enrollment and Contracting to ensure timely coordination of services to the SKSC members from the time of notification of enrollment to disenrollment from the program.
The individual will develop a strong working relationship with the Department of Children and Families (DCF) and MassHealth, and will communicate regularly with these external partners on matters pertaining to member enrollment and disenrollment, monthly clinical review team meetings and sharing of individualized member care plans (ICP) and other key program documents.
The individual will be a champion of the SKSC program internal to BMCHP, in terms of problem solving and building awareness, and pride in and commitment to the SKSC program as well as with DCF.
KEY FUNCTIONS/RESPONSIBILITIES:
- Maintain and track new member enrollment notifications
- Under the direction of the Manager, assign care managers to newly enrolled members using program assignment rules to include geo access and caseload management
- Maintain active master member roster list that is available to all key stakeholders
- Track and monitor member reassessment and disenrollment process, documentation and timeline
- Ensure ongoing communication of member enrollment status within the SKSC program via timely notification and update to tracking reports on established share point site
- Collaborate with the SKSC clinical team, and the BMCHP pharmacy, utilization management, and DME vendor to ensure members receive needed services through proactive monitoring of DME, pharmacy, medical service authorizations
- Coordinate and schedule the monthly Clinical Review Team meetings with DCF, EOHHS, and the SKSC clinical team
- Ensure timely distribution of the SKSC Quarterly ICPs (Individualized Care Plans)
- Build and manage open cases in the Care Management System
- Serve as the administrator for the SKSC SharePoint site, maintaining accessible documentation to support the SKSC program and ensuring all documents within the site are current and accurate. This includes maintaining accuracy of member rosters, member face sheets, CRT meeting documents, program letters and communication templates, policies, procedures and workflows and educational material
- Works with Public Partnerships and Member Services on inquiries from MassHealth, DCF, members, and providers and families to problem solve and provide timely information
- Provide administrative support for regular meetings this includes the development of agendas, taking meeting minutes and circulating follow-ups for weekly clinical team meeting and monthly CRT meetings
- Serves as the initial contact for calls and emails into the SKSC program designated triage line, during normal business hours
- Identifies opportunities for improvement in administrative workflows and processes Other duties as assigned
- Regular and reliable attendance is an essential function of the position
QUALIFICATIONS:
EDUCATION:
- Bachelor’s degree in a Healthcare related field or equivalent combination of education and relevant work experience
EXPERIENCE:
- At least 3 years of office experience, specifically in either a high volume data entry office, customer service call center, or health care office administration department
- 3 or more years of healthcare experience
- Experience with health plan utilization/claims
- Prior customer service experience
- Computer work experience that required active use of 2 or more software programs
EXPERIENCE PREFERRED/DESIRABLE:
- Prior health plan experience
- Experience with FACETS or clinical care management documentation systems or other electronic medical records, other healthcare databases
- Experience working in Sharepoint
- Experience with Medicaid population
- Experience with pediatric patients
- Bilingual skills, fluency in Spanish
COMPETENCIES, SKILLS, AND ATTRIBUTES:
- Demonstrated ability to use healthcare clinical systems for documentation purposes; ability to effectively navigate systems
- Excellent customer service and diplomacy skills
- Effective communication skills (oral and written) with ability to successfully collaborate across various functional departments and external constituents such as medical and other service providers and State agencies
- Ability to process a high volume of requests with a 95% or greater accuracy rate
- Proven process improvement skills
- A strong working knowledge of Microsoft Office products, including Excel
- Demonstrated ability to successfully organize and manage projects
- Detail oriented and high degree of independent judgment
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Required Skills
Required Experience