TOC Case Management Coordinator

MedPOINT Management; Los Angeles (CA); On-site; USD 26,000 - 32,000; Full time

Job summary

MedPOINT Management is seeking a TOC Case Management Coordinator to coordinate care for members recently discharged from one acute setting to another under the supervision of the Lead Case Management Coordinator.

Responsibilities include opening/closing cases, reviewing authorizations, uploading documents, and distributing tasks to the Case Management Team. You will ensure timely engagement with members and maintain system trackers to prevent readmissions.

Qualifications

• High school graduate or GED equivalent.
• Minimum of two years’ experience in a call center environment; health plan or medical group call center experience preferred.
• Proficient in Microsoft Word, Excel, and PowerPoint.

Responsibilities

• Open and close cases accurately and in a timely manner.
• Review authorizations and insert TOC notes into member files.
• Upload and document relevant materials (TOC Packet, History & Physical, Progress Notes, etc.).
• Distribute cases to the Case Manager via email.
• Update condition codes in AccessPoint.
• Contact members within 72 hours post discharge to engage.
• Coordinate care with medical network and arrange post-discharge appointments.
• Maintain CM Tracker and distribute cases to the team for follow-up.
• Respond to emails within 24 hours and attend mandatory trainings.

Skills

Data Literacy

Critical Thinking

Education

High School Diploma or GED

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Under the direct supervision of the Lead Case Management Coordinator, the TOC Case Management Coordinator performs major clerical work primarily responsible for coordinating care for members who have discharged from one acute setting to another. Daily work incudes compliance with State, Federal and Health Plan as mandated.

Duties and Responsibilities:

• Responsible for opening and closing cases
• Responsible for completing and closing tasks
• Responsible for reviewing authorization and retrieving IP TOC notes to insert in members file in the CM module/POPIQ
• Responsible for uploading, documenting pertinent information and documents (Ex: TOC Packet, History & Physical, Progress Notes, Consultations, Operation Reports, Etc.).
• Responsible for distributing cases in a timely manner to the assigned Case Manager via email
• Responsible for updating condition codes on AccessPoint
• Responsible for conducting outbound calls for engagement to members within 72 hrs. post discharge.
• Accommodate the team with coordinating care for members according to the discharge summary.
• Assists with contacting the member’s medical network for coordination of care purposes
• Retrieves readmission reports, and daily discharge lists to distribute cases accordingly to the Case Management Team for further follow up
• Assist with faxing documents to PCP regarding member coordination of care and status
• Responsible for retrieving member’s disposition if not provided
• Arranges post discharge appointments for members when needed
• Follows up with providers and specialists to coordinate further care for members and assure services have been rendered
• Updates the CM Tracker
• Works with the TOC Case Manager to assist with prevention of readmissions
• Manages TOC notification inbox and distributing cases to nurses, achieving the benchmark of minimum 5 referrals per hour
• Provides coverage for fellow TOC Coordinators on both the Episodic and Regulatory teams, including but not limited to reports, case opening, and case distribution
• Accountable for attending all mandatory team huddles and meetings
• Ensure emails are responded to within 24 hours
• Accountable for completing trainings provided by MPM and HP
• Informs management of any issue gathered from communication
• Participates in other assignments as required
• High school graduate or GED equivalent
• Minimum of two years’ experience in a call center environment; health plan or medical group call center experience preferred.
• Computer Proficiency on Microsoft Word, Excel, and PowerPoint

Skills and Abilities:

• Data Literacy
• Critical Thinking

Salary Range:

• $19 - $23 hourly