Telephonic Care Coordinator (Bilingual Spanish, MA, Remote, Pacific Time)

Location: Remote CA Outside Bay Area

Remote Type: Fully Remote

Time Type: Full time

Job Description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Health is seeking a bilingual Spanish care coordinator to join the remote Care Anywhere team. The Care Coordinator supports a transitions-of-care (TOC) focused, post-discharge outreach workstream centered on timely telephonic outreach to members following hospital and skilled nursing facility discharges.

The Care Coordinator will spend most of the workday conducting outbound member outreach. Success in this role requires someone who is comfortable and enjoys speaking with members on the phone throughout the day, consistently completes time-sensitive outreach, and demonstrates strong follow-through, organization, and accountability.

This is a high-volume, phone-based position responsible for engaging members, scheduling timely follow-up care, coordinating identified needs, and completing required documentation.

This position follows a Pacific Time work schedule. Candidates must be available to work one of the schedules below in Pacific Time, regardless of their local time zone.

Schedule: Mondays - Fridays
• Option 1: 8:00 AM - 5:00 PM Pacific Time (with 1-hour lunch)
• Option 2: 8:30 AM - 5:30 PM Pacific Time (with a 30-minute lunch)

General Duties / Responsibilities:

• Conducts high-volume outbound telephonic outreach to members following Hospital and SNF discharges.
• Follows established, time-sensitive outreach protocols and consistently completes required outreach attempts and follow-up activities.
• Engages members telephonically to assist with scheduling timely follow-up appointments with Care Anywhere providers and other appropriate healthcare resources.
• Uses established scripts and questionnaires to guide member outreach and accurately capture required information.
• Completes timely and accurate documentation of member outreach, outcomes, and follow-up activities across required systems.
• Creates cases, tasks, and completes documentation in the Case Management module for Hospital and SNF discharges.
• Reaches out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, provider appointments and follow-ups, and other care coordination needs as applicable.
• Requests and uploads medical records from Hospitals, SNFs, PCPs, Specialists, and other healthcare providers as needed.
• Complies with tasks assigned by nurse and, as appropriate, documents accordingly.
• Works as a team with clinical and care management staff to engage and manage assigned members.
• Manages new alerts and escalates changes in condition, admission, discharge, new diagnosis, or other clinical concerns to the appropriate clinical team member.
• Establishes relationships with members, earns their trust and acts as patient advocate.
• Assists with outreach activities and provides cross-coverage for other member needs as required based on business needs.
• Assists with maintaining and updating member records.
• Assists with mailing or faxing correspondence to members, PCPs, Specialists, and other healthcare providers as needed.
• Meets specific deadlines and prioritizes workload according to department policies, standards, and member needs.
• Maintains confidentiality of information between and among health care professionals.
• Other duties as assigned by CM Supervisor, Manager or Director of Care Management.

Job Requirements:

Experience:
• Required: Minimum 1 year experience working in Health Care such as Health Plan, Medical office, IPA, MSO. Experience conducting frequent or high-volume telephonic outreach to patients or members. Experience interacting directly with patients or members and supporting healthcare-related scheduling, outreach, or front-office activities.
• Preferred: Experience with transitions of care (TOC), post-discharge outreach, hospital or SNF discharge follow-up, care management, or population health outreach. Experience requesting medical records from Hospitals, SNFs, physician offices, or other healthcare facilities. Experience assisting members/patients with authorizations, referrals, scheduling appointments, identification of resources, or related care coordination activities.

Education:
• Required: High School Diploma or GED.

Completion of accredited Medical Assistant program.
• Preferred:

Training:
• Required:
• Preferred: Medical Terminology training.

Specialized Skills:
• Required:

• Able and willing to spend most of the workday conducting outbound telephonic member outreach.
• Able to consistently perform time-sensitive outreach and follow established outreach and documentation requirements.
• Able to engage members professionally and empathetically by telephone while gathering information, completing questionnaires, and coordinating appropriate follow-up.
• Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Communicates effectively using good customer relations skills.
• Able to communicate positively, professionally, and effectively with others; provide leadership, teach, and collaborate with others.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Knowledge of Managed Care Plans.
• Knowledge of Medi-Cal.
• Proficient Computer Skills, 35 WPM (Microsoft Outlook, Excel, Word).
• Mathematical Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
• Bilingual English / Spanish.

Licensure:
• Required: None
• Preferred: None

Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and / or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pay Range: $41,472.00 - $62,208.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.