TITLE: Disease / Case Coordinator
DEPARTMENT: Health Services
REPORTS TO: Disease / Case Management Nurse
FLSA: Non - Exempt

Position Summary: The role of the Disease / Case Coordinator is to augment, support and function as an extension to the Disease/Case Management Nurse and the interdisciplinary team. The role requires proactive and collaborative communication with members, providers and community resources, to support and promote optimal clinical outcomes for identified members.

Essential Roles and Responsibilities:
I. General Duties
  • Supports the Disease/Case Management Nurse in all aspects of the program.
  • Coordinates the identification of members through existing programs by tracking claims, pharmacy data, and monitoring the care gap indexes.
  • Initiates outbound calls to participants to encourage program participation and conducts non-clinical assessments, collecting demographics and client information.
  • Collaborates with the Disease/Case Management Nurse on outreach programs.
  • Coordinates with healthcare team and members to arrange follow-up and encourage compliance.
  • Run reports and coordinates with the nurse in tracking and trending.
II. Knowledge, Skills, and Abilities:
  • Knowledge of Medical Terminology
  • Excellent customer service and telephone skills
  • PC skills with ability to extract data and coordinate information between systems
  • Ability to actively listen and communicate information and ideas, both verbal and written, so others will understand.
  • Extraordinary organizational skills along with the ability to work independently
  • Good critical-thinking skills
  • Ability to take direction and prioritize workload, appropriately
  • Detail oriented
  • Ability to multitask
III. Minimum Qualifications
  • At least 2 years previous experience in healthcare environment or physician office
  • Ability to maintain the highly confidential nature of member Personal Health Information (PHI)
  • High School graduate with additional coursework or two years’ college education
  • Demonstrated personal computer and word processor skills
  • Above-average communication skills, ability to work efficiently and effectively with both employees and managers.
VI. Core Competencies
  • Communication: Maintains professional and positive interaction with physicians, offices, members and health plan staff. Presents information in a clear and concise format, ensuring mutual understanding through discussion, questions and feedback.
  • Continuous Improvement: Actively participates in continuous improvement activities, identifying opportunities, enhancing current approaches and developing new ideas with the overall objective of continuous improvement. Proactively seeks new skills and knowledge and is able to apply them to the job.
  • Customer Service: Exceeds internal and external customers’ expectations by demonstrating understanding of customer/member needs to ensure effective delivery of a solution, product, or service that best fits their needs.
  • Productivity: Effectively and efficiently uses time and resources to achieve work-related goals, organizing activities according to priority and the need for coordination and cooperation with others.
  • Problem Resolution/Decision-Making: Applies considered judgment to make decisions within assigned job duties, based on critical analysis and evaluation of the situation, the options, and their implications to elicit a positive outcome. Promotes dialogue to seek resolution of conflicts or problems with others. Seeks and offers solutions to problems.
  • Accountability: Takes responsibility for assigned work, following through to ensure goals are met or exceeded. Takes responsibility for decisions and/or actions in the job.
  • Responsiveness to Change: Demonstrates an openness to new ideas and ways of working; adapts to changing needs and situations; approaches issues with an openness to change and a willingness to pursue different approaches to achieve a positive outcome.
  • Teamwork: Works cooperatively and collaboratively with others, contributes to the “team” in its broadest sense; encourages participation, commitment, and an active contribution from him/herself and others in the pursuit of common goals. Actively seeks ways to apply knowledge and skills to help others.