Care Coordinator Utilization Agent

Job Summary:

Responsible for hospital bed management at Moanalua Medical Center, including assistance with outside ED and hospital coordination for the repatriation of Kaiser Health Plan members, air and ground transportation, messaging and other duties, as necessary. Also, responsible for providing timely response to all inbound phone calls for the Care Coordination Center (CCC), including receiving initial patient information and demographics, eligibility information, request for service, and triaging calls to the appropriate provider (CCC Medic, RN or Physician). Documentation of member/ patient information into computerized data management systems and in manually maintained data files. Answers inquiries and educates member/ patient, physicians and hospitals, as necessary. Collaborates with the House Supervisor and Emergency Room team to ensure appropriate and timely patient hospital throughput.

Essential Responsibilities:

Maintains bed tracker for Moanalua Medical Center. Collaborates with House Supervisor, Emergency Room, etc. for bed placement and patient throughput. Assigns beds at Moanalua Hospital for patients requiring an inpatient admission. Outreach to non-Kaiser Permanente hospitals for coordination and repatriation of Kaiser Health Plan members. Assist with coordination of Air & Ground Transportation. Assist with referral entry in Tapestry for Kaiser Health Plan members admitted to non-Kaiser Permanente facilities. Provides timely response to incoming calls and triages calls to appropriate provider. Initiates data collection from incoming call, to include: patient information and demographics, eligibility, and reason for call. May also document in the Kaiser Permanente electronic medical record. Assists with data entry in electronic medical record, computerized data management systems, and manually maintained data files. Collaboration with other services, e.g. membership services, to answers inquiries and educate patients, physicians and hospitals on covered benefits and charges.

Qualifications:

Basic Qualifications:

Experience Minimum six (6) months of administrative experience in a health care facility or related experience. Education High School Diploma or General Education Development (GED) required.

License, Certification, Registration N/A Additional Requirements:

Experience applying analytic techniques and computer skills to hospital data. Strong analytic and verbal skills. Expertise with tracking, spreadsheets and graphic computer systems operating on PC mainframes. Knowledge of health plan benefits. Understanding of medical center operations, complex health systems, with the ability to quickly grasp regional policies, contractinterpretation of out-of-plan medical services.

Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

Associate of Arts or Bachelors degree preferred.