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.

Alignment Health is seeking a Remote Care Coordinator located in North Carolina to join the remote Care Anywhere (CAW) team.

As a care coordinator, you will supports the CAW field providers with scheduling, outreach, and managing all care coordination needs for high-risk members enrolled with the CAW program.

Schedule: Mondays - Fridays
- Option 1: 8:00 AM - 5:00 PM Eastern Time (with 1-hour lunch)
- Option 2: 8:30 AM - 5:00 PM Eastern Time (with a 30- minute lunch)

General Duties / Responsibilities:

• Manage (4) provider schedules ensuring that schedules are filled.

• Prepare charts for upcoming home visit appointments (check member eligibility, gather records needed by the provider prior to the home visit)

• Conduct outreach for scheduling, appointment confirmation calls, wellness checks for high risk members, and to providers / pharmacies for member needs.

• Daily inbound / outbound call quota of minimum 60 - 80 calls / day.

• Obtain medical records from provider offices, hospitals, and skilled nursing facilities (SNF’s) and upload medical records to electronic medical records (EMR.)

• Submit referral authorizations to independent physician associations (IPA) / medical groups for specialty, durable medical equipment (DME), and home health (HH) services.

• Coordinates lab orders and transportation for high-risk members.

• Documentation via EMR for inbound / outbound calls.

• Support SMS and member outreach campaigns.

• Assist nurse practitioner (NP) team with visit preparation needs:

  • Appointment reminders to members

  • Assign members to NP in electronic health records (EHR)

  • Provide needed documentation to NP for visits each day

• Direct inbound calls from members / family related to medication refills

• Assist with maintaining and updating members' records

• Assist with mailing or faxing correspondence to primary care physician (PCP’s), specialists, related to, as needed.

• Attend CAW meetings / presentations and participates, as appropriate.

• Recognize work-related problems and contribute to solutions.

• Work with outside vendors to provide appropriate care needs for members

Job Requirements:

Experience:

• Required: Minimum 1 experience entering referrals and prior authorizations in a healthcare setting.

• Preferred: Minimum 2 years' healthcare experience.

Education:

• Required: High School Diploma or GED. 

• Preferred: Completion of a Medical Assistant program from an accredited institution.

Training:

• Preferred: Medical Terminology

Specialized Skills:

• Required:

• Able to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.

• Knowledge of ICD9 and CPT codes

• Knowledge of managed care plans

• Strong computer skills

• Proficient in Microsoft Office Suite (Outlook, Excel, Word)

• Able to type, minimum 35 words per minute (WPM)

• Effective written and verbal communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;

• Knowledge working in Athena (not mandatory)

• Language Skills:  Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Able to write routine reports and correspondence.  Communicates effectively using good customer relations skills.

• Mathematical Skills:  Able to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s.  Able to perform these operations using units of American money and weight measurement, volume, and distance.

• Reasoning Skills:  Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Able 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.

• Preferred: Bilingual English and Spanish

Licensure:

• Required: None

• Preferred:

• Medical Terminology Certificate

• Medical Assistant Certification

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.

Pay Range: $38,569.00 - $57,853.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

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.