Care Coordinator

US-NY-New York
Requisition ID
Department Name
Medicaid/Commercial Care Management


Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York. With more than 4,000 employees, a network of nearly 30,000 providers, and revenues in excess of $8.6 billion, Healthfirst is one of the largest health plans in the New York City area. Our members are our North Star, and our mission is guided by their needs and preferences in ensuring a superior experience and access to the highest quality healthcare when and where they need it. Healthfirst’s commitment to quality and member satisfaction has helped us earn top ratings for HMO health plans in New York City. We know that employees shape our company and connect us to our communities, and we look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers: - Dream Big, Plan Wisely - Break Down the Walls - Think Critically, Speak Up, Deliver with Pride - Inspire Through Trust, Lead By Example - Be Unstoppable The Care Coordinator is responsible for performing care management services in order to support members who require service level assistance in navigating their health care system. They are aligned within community-based care management teams or within the Care Management Call Center.   This is a paperless work environment requiring daily hands-on administration of multiple electronic Patient Health Information (PHI) databases and security requirement tools such as encryption. These systems include, but are not limited to, CCMS (CareEnhance Clinical Management Software), Sunguard Macess Service Module (electronic archiving), RightFax, VoIP, Virtual Work Platforms (using VPN), scanning and creating .pdf files (Adobe Acrobat), and MS Office 2010 software (such as Word and Outlook).   Healthfirst is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status  or any other characteristic protected by law.


 Duties and Responsibilities:


  • For Call Center: Receive Incoming calls from members regarding benefit questions/issues, care coordination, inquiries about program, provision of educational materials, connecting to their care manager, and screening assessments to identify risk factors requiring case management intervention. Confirmation and documentation of accurate Members demographic information and Documents calls in designated CM system. 75% of time if just assigned to call center.
  • For Care Management County teams:  Carries an assigned case load of members who require short term care coordination and health navigation. Required to identify goals focused around access and navigation and interventions to achieve goals and monitor progress. Create authorizations for services where approved and applicable. Case load of up 200 cases. 75% of time is just community based.
  • For Care Management County teams: Works within the interdisciplinary care team to support timely communication of member issues or needs and monitors screening of members effectively to improve quality and cost outcomes.
  • Member outreach for HEDIS/STAR measures. Assesses calls and if necessary, refers to appropriate staff, both clinical and non-clinical, for further review and participates in other quality initiatives.
  • Receives referrals from right fax and within the interdisciplinary care team and data enters into CareEnhance Clinical Management Software (CCMS).
  • Performs outreach calls to members to confirm services are in place and determine discharge planning follow-up required and calls providers to confirm receipts of care plans.
  • Additional duties as assigned.


Minimum Qualifications:

    • High school diploma or GED
    • Certified Medical Assistant (CMA), Certified Nursing Assistant (CNA) or Medical Office Assistant Diploma (MOA)
    • Knowledge of medical terminology.
    • Work experience with screening or triage of patients such as in a physician's office, clinic, hospital or long-term care.
    • Ability to attend a 1 week in-office orientation in NYC or NC.   

Preferred Qualifications:  

  • Experience in managed care or other area of the healthcare industry working in a Call Center environment or Care/Case Management Department.
  • Demonstrated ability to document calls into a computer system.


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