Under the direction of the Executive Director of Accountable Care Organization (ACO), the ACO Care Management (CM) Assistant serves as a support resource to ACO patients, physician practices, case managers and the health plan. The ACO CM Assistant will assist patients in their understanding of provider options, coverage benefits, and direct patients to the Nurse Case Manager or Social Worker when that would benefit the patient.
Essential Functions and Responsibilities of the Job
Ability to communicate both verbally and in writing
Ability to complete work independently and collaborate with internal and external team members and participate in ACO and/or related meetings and functions
Ability to understand medical terminology or concepts
Computer literacy with ability to work within several internal and external on line and Web based systems, reports and in Microsoft Office (Word, Excel)
Ability to use basic math skills
Understanding of privacy and HIPAA standards
Essential Job Outcomes
Runs reports from multiple systems (e.g.., Health Catalyst, Epic, and PCMS) to identify patients for contact, open encounters in Epic Health Planet module and assign to nurse care manager.
Patient outreach using compassionate customer service with the goal to inform the patient of care gaps and facilitate getting care gaps closed
Review reports to identify enrollment volume and report discrepancies using the established escalation process.
Serves as support to the ACO Case Management Team, Network Management, and the physician offices to ensure quality outcomes are optimized by reducing care gaps and increasing member engagement.
Holds a general understanding of healthcare payment methodologies when researching benefit issues and sharing findings to patients and providers
Assists in the distribution of materials to the provider’s offices, such as tool kits, ACO network provider cost and quality data.
Detail oriented with continual attention to optimize efficiencies in the development of solutions for provider offices who identify, care for, and engage ACO patients.
Runs reports daily, monthly and for team meetings to optimize population management.
Refers members to and collaborates with appropriate ACO Health Plan retained functions in Case Management including; Transplant, Transgender Reassignment Surgery, Bariatric Surgery, Complex Newborn/NICU, Eliza (IVR Warm Transfer), Behavioral Health, Investigational/Experiment services, Benefit Substitution Period, Out of ACO Service Area
“Other duties as assigned”
A minimum of one (1) year of Managed Care related experience with a general understanding of HMO and PPO health plans, health care benefit designs, claims, physician office practice operations, medical terminology and or equivalent combination of education and experience
Previous ACO Program experience preferred
High School graduate or G.E.D. required
Associate degree (A.A.) or equivalent from a two (2) year college or technical school preferred
Medical background required; Medical Program or Certification preferred
Internal Number: MEM003345
About MemorialCare Medical Foundation
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.