Care Management Coordinator

Boston Children’s Hospital; Boston, Northern (MA, KY); Hybrid; USD 60,000 - 80,000; Full time

Job summary

Boston Children’s Hospital is seeking a Care Management Coordinator to support an ambulatory care team in implementing and maintaining patient care plans. The role provides non-clinical administrative support and coordinates referrals, communicating with patients, families, providers, and community resources.

Responsibilities include processing referrals for meds and therapies, obtaining prior authorizations, liaising with insurers, and assisting with patient inquiries and resources.

Qualifications

• High school diploma or GED required; associate degree preferred.
• At least 3 years of experience in care management or related work.
• Intermediate skills in MS Office (Excel, Outlook, Word) required.

Responsibilities

• Process referrals for care management (medications, therapy, DME, transportation).
• Review daily work assignments and priorities to address urgent requests.
• Coordinate with multidisciplinary team to communicate and coordinate care management activities.
• Obtain prior authorization approvals with insurance; assist denial/appeal processes and renewals.
• Liaise with clinical and non-clinical groups to ensure consistent communication across the care continuum.
• Assist patients and families with inquiries, provide resources and community referrals.
• Coordinate medication prescription requests including prior authorizations and specialty pharmacy setup.
• Manage extensive worklist of patient requests for timely submission and follow-up.

Skills

Care coordination

Education

High School Diploma / GED

Associates Degree

Tools

MS Office Excel

Outlook

Word

Job description

Position Summary

The Care Management Coordinator works in conjunction with a multi-disciplinary team within an assigned ambulatory/outpatient clinical setting to support the implementation and ongoing patient care plan/continuum treatment. Provides accurate and timely non-clinical administrative support. Coordinates all aspects of the patient referral process, collaborating with patients and families, providers, and community resources according to established guidelines.

Key Responsibilities

• Independently processes referrals for care management including, but not limited to, medications, skilled and private duty nursing, infusion and enteral therapy services, durable medical equipment and supplies, Home Care Agencies: Early Intervention Program (EIP), Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP) and transportation throughout the care continuum.
• Review daily work assignments and priorities to ensure critical requests are addressed.
• Collaborate and delivers clear, effective communication with multidisciplinary team members to coordinate care management activities within the assigned ambulatory/outpatient clinical setting.
• Work with insurances companies to obtain prior authorization approvals. Assist clinical team in coordinating pursuing denial/appeal process if needed. Plan and prioritize the coordination and tracking of the prior authorization renewal process.
• Serve as a liaison, working in conjunction with licensed clinical providers within assigned areas to ensure regular, and fluid communication with relevant clinical and non-clinical groups is ongoing by establishing connectivity between all areas throughout the care continuum process.
• Assist patients and families with inquiries, provide resources, educational literature, and direct them to community partners. Provide a high level of services and support. Assist with status regarding urgent or emergent requests and other inquiries.
• Coordinate medication prescription requests including but not limited to prior authorizations, verbal overrides, setting up specialty pharmacy accounts, verifying copays and exploring assistance options, referring to Social Work or assisting with Free Care if needed.
• Coordinate extensive worklist of patient requests to ensure timely submission, approval, and follow up of all requests.

Minimum Qualifications

Education

• High School Diploma/ GED required. Associates Degree preferred.

Experience

• 3 years experience in Care Management or related work is required.
• Intermediate skills in MS Office Excel, Outlook, and Word are required.