Mary's Center is committed to promoting diversity, equity and
inclusion (DEI) within our organization and the communities we
serve. We embrace diversity of experiences, ideas, and individuals,
and seek to bring a diverse group of candidates to the table.
Provides case management/utilization review and outreach in
order to engage a panel of patients. The overall goal of this
position is to enhance the quality of patient management and
satisfaction, to promote continuity of care and cost effectiveness
through the integrating and functions of case management,
utilization review, navigation, relationship development and
outreach. Ability to effectively identify patients' barrier(s) to
care and provide community resources based on individualized needs
in order to achieve positive patient outcomes. Complete a daily
spreadsheet reflecting productivity. Produce and submit a weekly
productivity spreadsheet report and patient tracking sheet
reflecting outreach and numbers scheduled.
This position reports directly to the MCO Panel Nurse
Essential Duties & Responsibilities:
To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily.
Oversee and coordinate care for a panel of patients through
outreach and engagement techniques.
Promote effective and efficient utilization of clinical
Mobilizes resources, as needed, to engage patients in order to
achieve expected clinical and quality outcomes within the desired
Identifies and addresses barriers to care on an as needed
Provide follow up and continued oversight to panel patients,
addressing any concerns and/or issues that arise.
Coordinate and communicate with clinicians in order to
facilitate patient's needs.
Work closely with the MCO Panel Nurse Manager and Managed Care
Organizations (MCO) to determine urgency for patients who have
chronic illness or other health needs.
Communicate at regular intervals with the appropriate Managed
Care Organization (MCO).
Understand patient scheduling and referral process.
Evaluate patient satisfaction, financial considerations, and
quality of care provided on an as needed basis.
Create, maintain, and disseminate data as required by Mary's
Center and/or the Managed Care Organization (MCO).
Serve as a patient advocate. Enhance a collaborative
relationship between Mary's Center and the MCO in order to maximize
the ability to meet patient's and family's needs.
Monitor trends in patient utilization data. Responds in a
collaborative way to alter trends to enhance effective and
efficient utilization of clinical resources.
Learn effective use of MCO portals
Contact MCO representatives on a regular basis in order to
promote communication and to follow up on projects.
Work on increasing HEDIS scores at Mary's Center
Ethics- Understand and respect the fact that workload varies;
accept urgent and/or non-urgent projects as delegated by
Interpersonal skills- Attempt to resolve issues in a positive
Identify barriers and also identify possible solutions.
Schedule a minimum of 75 appointments weekly. Send a copy of
daily appointments to Supervisor via email daily.
Employee may not arrive earlier than 8AM in order to leave early
without prior authorization from supervisor, per Mary's Center and
or/MCO Panel Dept. leave policy.
- Make vacation time off requests through Paycom a minimum of two
(2) weeks in advance. Please refer to Mary's Center call out policy
for other requests.
The requirements listed below are representative of the
knowledge, skills, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities
to perform the essential functions.
Education and/or Experience - Minimum of High School Diploma or
GED Equivalent. Must possess a minimum of 1 (one) year of
experience in direct patient care and/or medical assistant
certification or registration. Experience working in community
health settings with immigrant populations and/or maternal-child
health preferred. Bilingual in English and Spanish and/or other
languages a must. A thorough understanding and working knowledge of
patient confidentiality issues and HIPAA compliance/regulations are
Physical Demands - Regularly required to sit; frequently
required to reach with hands and arms; required to walk, stoop,
kneel, crouch, talk or hear; must be able to lift objects up to
twenty-five (25) pounds
Work Environment - In a typical clinical office setting with
quiet to moderate noise level and designate a home office space for