Care Coordinator, Chronic Kidney Disease (CKD) (Finance)

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.

The Chronic Kidney Disease Coordinator (CKD) Care Coordinator manages a panel of members diagnosed with Chronic Kidney Disease to ensure high quality services and care coordination activities are delivered to these high-risk members. The goal of the CKD care team is to educate, support, and empower self-care to improve kidney health and delay the need for renal replacement therapies (RRT). For people who do progress to End-Stage Renal Disease (ESRD), the CKD care team aims to facilitate a successful transition to RRT and address advance care planning.

Schedule: Monday - Friday, 8am - 5pm Pacific Time (Required)

GENERAL DUTIES/RESPONSIBILITIES:
1. Reviews Daily Registry for members with new late-stage CKD diagnosis.
2. Obtains medical records from Provider offices, hospitals, and SNF's and attaches medical records to authorizations.
3. Enters referral requests/authorizations in system.
4. Schedules initial, follow-up, and post-discharge appointments and will follow-up scheduling and re-scheduling of no-show appointments.
5. Assists Care Anywhere (CAW) NP team with visit preparation needs, as applicable.
_(a. Appointment reminders to members.
_(b. Assigns members to NP in HER.
_(c. Provides needed documentation to NP for visits each day.
6. Educates the patient on kidney disease and other factors impacting his or her care such as comorbidities, including diabetes and hypertension, physical challenges, lifestyle factors and psychosocial factors.
7. Proactively engages the patient in his or her care and coordinate with their community of providers to help ensure optimal dialysis starts when appropriate.
8. Provides risk assessment and member education on care and symptom management.
9. Supports coordination and enrollment into hospice.
10. Maintain documentation on members contacted.
11. Assist with continuity of care and notifies NP/nurse if members appear to be non-compliant or there is a change in condition.
12. Assists with maintaining and updating member's records.
13. Assists with mailing or faxing correspondence to PCP's, Specialists, related to, as needed.
14. Recognizes work-related problems and contribute to solutions.
15. Works with outside vendors to provide appropriate care needs for members.
16. Other duties as assigned by CM Manager or Director of Case Management.

Job Requirements:

Experience:

• Required: Minimum 1 year of experience entering referrals and prior authorizations.

• Preferred: 2+ Years healthcare experience.

Education:

• Required: High School Diploma or GED.

• Preferred: Medical Terminology college courses.

Training:

• Preferred: Coding and Medical Terminology

Specialized Skills:

• Required:

• Knowledge of ICD9 and CPT codes
• Knowledge of Managed Care Plans
• Basic Computer Skills, 25 WPM (Microsoft Outlook, excel, word)
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Language Skills: Ability to read and interpret documents and follow up on orders from NP's/MD's. Ability to read and follow instructions / procedure manuals. Ability to write routine reports and correspondence. Communicate effectively using good customer relations skills.
• 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.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.

• Preferred: Bilingual (English/Spanish) preferred, Knowledge working in Access Express/Portal, epic, essette (not mandatory).

Licensure:

• Required: None

• Preferred: Medical Terminology Certificate preferred

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.

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.

1. 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.

2. 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.
Pay Range: $41,472.00 - $62,208.00

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 .