Patient Care Coordinator

One Call Care Management

(Jacksonville, Florida)
Full Time
Job Posting Details
About One Call Care Management
No one looks forward to managing a Workers' Compensation claim. It can be a complex, time-consuming and costly experience. You need a partner who understands the process and can provide the expertise and services you require every step of the way.
One Call Care Management supports the Workers Compensation Industry goal of assisting patients’ maximum rehabilitation and timely return to work. In doing so, Patient Care Coordinators’ primary objective is coordinating patient care as well as delivering the highest customer service to ensure OCCM’s role in the marketplace is preserved.
* Exercising quality customer service skills, receive referrals and obtain all necessary patient, medical, and demographic information from a variety of referral sources via various communication methods to establish and coordinate medical products and services while utilizing company database to maintain all related and protected patient records. * Following department and company guidelines, intake any assigned incoming activity, inclusive of data entry of referrals into patient database (CSRD), addressing real time service issues and problem solving. * Triage all incoming requests based on date of receipt, date of service, and customer to ensure appropriate action is taken related to service level agreements. * Following department and company guidelines, attempt to secure authorization from carrier for all referred products and services by the utilization of various communication methods while following all applicable carrier and/or state mandated policies regarding the proper authorization documentation. * In accordance with department and company guidelines, utilize negotiation skills to assure the most cost effective products and/or services are provided to our customers without sacrificing company quality standards. * Utilize available software applications, company resources, and Internet to locate and identify vendors, products, pricing and healthcare information needed to staff referrals in timely manner, in accordance with physician orders and customer expectations. * Create and transmit purchase orders and affiliated documents in accordance with vendor contracted rates, state fee schedules, state rules & regulations, and carrier contracts. * Partner with Provider Relations to offer consistent feedback on overall performance of National Vendor Network. * Monitor status of all referrals to confirm successful delivery and/or completion of products and/or services through the use of various communication methods. * Per department guidelines, consistently and effectively update business partners and/or patients regarding status of referrals through the use of various communication modes inclusive but not limited to email, fax, and or telephonic. * Communicate effectively with both internal and external customers to assure that all referral needs are met in a timely manner, inclusive of recurring products and services. * Proactively identify, diagnose, and resolve challenges that may impact the successful delivery of products and services including evaluation of information and transactions to ensure accuracy. * Promote revenue flow by effectively and efficiently advancing all applicable referrals to billing unit for order creation, inclusive of prioritizing all billing related outstanding work orders. * Support financial aspects of client services cycle inclusive of providing accurate pricing quotes to carriers and assessment of profit margin while adhering to all state fee mandates and company pricing rules. * While demonstrating high levels of sensitivity and customer focus, verify and validate the accuracy of all referral information as well as attempt to obtain any missing needed information in order to effectively process referral and invoice carrier. * In compliance with HIPPA regulations regarding the protection of Personal Health Information (PHI), utilize department mandated format to record all related referral content and activity, inclusive of medical and demographic information, into the company approved time locked database. * Following department and/or company procedure appropriately populate all tracking logs and/or reports; examples include automated call response reports, inventory logs, and task detail tracking related to both outsourced assignments and individual production. * Acting as a liaison between all internal and external customers, proactively research and resolve outstanding issues in order to foster collaborative relationships. * Follow internal escalation process when service agreements and/or customer satisfaction is at risk. * Consistently work with attention given to specific carrier/patient customer preferences, guidelines, and contractual service level agreements. * Disseminates referral information and patient needs to integrated team members in other departments, preferably via e-mail as product and/or services require. * Through continuous learning, acquire broad foundation of product, department, and company knowledge both by self evaluation and active participation in department, division, and company training initiatives.
Ideal Candidate
**Knowledge, Skills, Abilities, and other characteristics:** * Critical Thinking- Uses logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. * Positive Attitude- Finds the most effective and efficient way to complete tasks, regardless of obstacle, while continually offering support to peers through quality teamwork. * Flexibility/Adaptability- Able to accept change and engage it. * Active/Continuous- Learner Recognizes own strengths and weaknesses and actively seeks skills, techniques, and methods to develop and enrich. * Call center experience preferred. **Education/ Work Experience:** * High School Diploma or Equivalent (GED) * Prior sales/negotiating skiills required * Healthcare experience a plus * High-end retail sales people strongly encouraged to apply * Bilingual- Spanish Preferred **Physical/Emotional Demands and Work Environments:** * For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear. * For roles located in the field; this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands and fingers, speak, and hear. * The employee is occasionally required to stand, walk, and lift objects (up to 10lbs weight; up to 4 ft. height). * Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus. * The work environment utilizes florescent lighting; noise level is moderate. * The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload. * Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position. * Please be advised the job description is subject to change at any time.


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