Care Coordination 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 answer inquiries and educate patients, physicians and hospitals on covered benefits and charges.