Emergency Room Coordinator

HEALTH PARTNERS is the Philadelphia area’s only health plan that’s owned by a partnership of local hospitals and health systems.  We continually strive to improve the health outcomes of our members, building a healthier community in the process. Our corporate commitment to operate with respect and dignity in all relationships stands behind everything we do.  We offer excellent benefits, competitive salaries and a great 401(k) Plan.  We are seeking an Emergency Room Coordinator to join our Outpatient Services department.

 

GENERAL DESCRIPTION:  Working under close supervision, collect and process information related to Emergency Room (ED) utilization and outpatient services and assure that services are coordinated and authorized for eligible members.  The Emergency Room Coordinator provides telephonic outreach, education, and counseling to members targeted by the Care Management department.

 

KEY REQUIREMENTS: High school diploma. Two years’ health care experience.  Experience working in a managed care environment preferred. Bilingual preferred.  Knowledge of medical terminology and medical conditions.  Computer literacy, including familiarity with Windows and Microsoft Office programs.  Ability to work independently.  Ability to work efficiently, with excellent time management skills.  Excellent communication skills both verbal and written.  Must have professional, courteous telephone manners.  Ability to work well with all types of providers/members.  Ability to maintain professional demeanor and confidentiality.  Sensitivity to the needs of every individual to be treated with respect and fairness.  Regular and punctual attendance is a condition of employment. 

 

PRIMARY RESPONSIBILITIES: Verify member’s eligibility via internal eligibility system and/ or DPW terminal.  Conduct telephonic outreach to members to educate on appropriate use of ED and encourage utilization of Primary Care Provider (PCP).  Outreach to member and complete script loaded in Care Planner and process outcomes according to operational guidelines.  Maintain accurate data entry into designated software systems.

Coordinate internal and external services/resources for members.  Refers members to appropriate HCM departments (i.e. Disease Management or Special Needs).  Coordinate follow-up appointments for members, educate member about benefits such as Medical Assistance Transportation Program, etc.  Identify duplication of services and opportunities for improvement.  Assist in PCP selection with member, if member chooses to change providers.  Educate members on process to requests any of the following services from providers for homecare, infusion, injectables, DME and transportation using approved criteria as per Health Partners guidelines.  Send written communication to PCP informing them of members’ visit to emergency room.  Collaborate with clinical staff for appropriateness of care plan. Responsible for completing and managing assigned workload (outreach calls per day).  Provide telephone service in a prompt and courteous manner.  Respond to faxed list from hospital system in set timeframes.  Coordinate with discharge planning, UM, ICM, SNU to facilitate timely approval and coordination of services. Participate in the development and implementation of all departmental policies, procedures and goals, and assure numeric targets for phone lines are met. Assist management with IS (when needed) in development of database to facilitate outreach. Review developed reports with Team Lead and Director to establish trends/patterns.   Alert management to frequent flyers in the ED and refer to SNU for case management.  Review systems to check member’s adherence and utilization patterns.  Comply with Regulatory and Health Partner documentation standards.  Meet Department and Corporate goals.  Assist in additional outreach projects. Promote excellent communication between Quality Management (QM), Utilization Management (UM), Disease Management (DM) and Special Needs Unit (SNU).  Other duties as assigned.