High Risk Coordinator

• Contacts patients, physicians, caregivers, and family members on a daily basis for screening, intervention, education, and follow up as directed by the High Risk Clinical Team.
• Identifies potential transition of care needs including hospital admission, discharge, emergency department utilization, and post acute care requirements.
• Conducts outreach to high risk patients to support care plan adherence, medication compliance, appointment scheduling, and barrier resolution.
• Assists patients in navigating the healthcare system and accessing appropriate levels of care.
• Provides culturally competent, patient centered communication and customer service at all times.
• Collaborates with inpatient and outpatient clinical and administrative staff daily to identify patients requiring high risk intervention and follow up.
• Participates in daily interdisciplinary rounds with Medical Director, care management, case management, and clinical teams as appropriate.
• Reviews case notes and care plans with High Risk Clinical Team and documents interventions in designated clinical platforms.
• Communicates changes in patient status, barriers to care, and risk factors to appropriate clinical staff in a timely manner.
• Coordinates transitions of care including hospital discharge follow up, post acute placement, home health, and specialty services.
• Interfaces with providers, community agencies, home care agencies, skilled nursing facilities, and DME vendors as needed.
• Assists with scheduling follow up appointments, diagnostic testing, and specialty referrals.
• Supports medication reconciliation and adherence initiatives in collaboration with licensed clinical staff.
• Processes prior authorization requests, approvals, and denials for high risk patients following established protocols and turnaround times.
• Tracks authorization status and communicates updates to providers, patients, and internal teams.
• Maintains accurate documentation and timely updates in care management systems.
• Utilizes internal and external resources to identify gaps in care and support quality and utilization management initiatives.
• Supports management of high risk populations including patients with chronic and complex conditions such as congestive heart failure, diabetes, cancer, asthma, and COPD.
• Plans, prioritizes, and manages a high volume workload while meeting productivity and quality expectations.
• Participates in special projects, process improvement initiatives, and departmental activities as assigned.

• Excellent customer service, interpersonal, and communication skills
• Strong organizational and time management skills with attention to detail
• Ability to manage multiple priorities and meet deadlines in a fast paced environment
• Ability to work independently and as part of a multidisciplinary team
• Knowledge of care coordination, transitions of care, and managed care principles
• Knowledge of health plan benefits and prior authorization processes
• Strong problem solving and critical thinking skills
• Demonstrated proficiency in Microsoft Office (Word, Excel, Outlook, Teams)
• Knowledge of electronic medical records (EMR) and care management platforms preferred
• Keyboarding skills of at least 40 words per minute with accuracy

• High School Diploma or equivalent required
• Associate Degree in healthcare, business, or related field preferred
• Care Coordination, Medical Assistant, or Healthcare Administration training preferred

• 2–4 years of Managed Care, Care Coordination, Case Management, or related healthcare experience required

• Experience working with high risk or complex patient populations preferred

• Knowledge of health plan benefits and utilization management processes preferred
• Experience with prior authorization and referral management preferred
• Experience working in value based care or population health environment preferred

Department: Clinical Services
This is a full time position