• Decrease avoidable ED utilization and related hospitalizations
• Decrease duplicative ED tests and procedures
•  Connect targeted Medicaid and uninsured ED visitors with primary care health homes and other health resources through patient education and by encouraging, counseling and coaching the patient on the benefits of a primary care health home.

• Provide clinically appropriate, timely, managed and distributed specialty care for low income, uninsured individuals in order to improve health outcomes, care management, efficiency and effectiveness of care and in turn, to reduce avoidable utilization and the total cost of care.

POSITION-SPECIFIC COMPETENCIES/ESSENTIAL FUNCTIONS/DUTIES & RESPONSIBILITIES:

• Manage the MyHealthDIRECT scheduling system for CHC including adding and deleting appointments based on CHC volume capacity and payer mix needs.
•  Monitor for receipt of medical record from ED, and distribution per CHC process.
•  Maintain current contact information on MyHealthDirect fax cover sheet, contacting MyHealthDIRECT with changes.
•  Collaborate with Triage or Clinic Nurse when necessary to determine if scheduled appointment meets patient health care needs.
•  Schedule all EDCC patient appointments in the patient management system.
•  Partner with primary care team in delivery of patient’s plan of care.
•  Verify insurance information with appropriate HMO/IPA or insurance carrier.
•  Attend EDCC meetings on behalf of Primary Care team.
• Improve screening for patient insurance eligibility
• Streamline application processes between the safety-net clinic and health system for patient financial assistance
• Improve patient education and referral management
• Increase understanding of the specialty care needs of the uninsured and current patterns of accessing care
• Identification of specialty services that could be more effectively/efficiently delivered in the primary care setting
• Heighten awareness of the complexity of, and resource requirements for effective transition care management among safety-net primary care providers, specialists and hospital/health systems
• Attend seminars, training sessions, and meetings to keep abreast of the changing insurance policies and procedures, as needed.
• Comply with federal, state and local regulations regarding patient confidentiality and HIPAA.
•  Contact patient via phone to introduce clinic, educate on value of primary care health home, encourage attendance at appointment and answer any questions
• Meet patient during the first visit to continue educational process on benefits of a primary care health home and on appropriate use of the ED and how to access medical services in the future
   
• Evaluates the patient’s first visit to CHC to determine effectiveness of initial education and assist patient with needed community resources.
   
• Contact no-show patients to determine why they have missed their appointment and encourage rescheduling of appointment, reinforcing importance of a primary care health home
   
• Collect, maintain and transmit data as needed for ED Care Coordination measurement requirements and improvement activities
   
• Participate consistently in Joint Assessment & Referral/Intake and Retention Work Group and other ED Care Coordination improvement activities

POSITION REQUIREMENTS:

•  Education:           Associates Degree in Healthcare Administration, Social Work or related field, with knowledge of community resources and medical terminology.
• Experience:          Experience in a fast paced patient care environment.  Excellent organizational and communication skills, accuracy and confidentiality.  Background experience in insurance regulations, medical procedure/surgery scheduling, and medical triaging helpful, but not necessary. Two or more years’ experience in a primary care setting preferred.
• Expertise:              Knowledge of medical terminology. Basic CRT computer skills. Excellent interpersonal skills, empathy and tact, when dealing with insurance companies, patients and other health care facilities. Must be willing and able to assume the responsibilities delegated by the Care Coordinator, to provide efficient and effective coordination of care. Must be willing to adapt to changing situations and circumstances. Requires good communication skills.
• Language:            Ability to read and comprehend instructions, short correspondence, and memos.  Ability to prepare effective correspondence.  Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Hours of Work:     May vary based on Organizational need.
• Travel:                  May vary based on Organizational need.