Member Services Coordinator, Jordan Valley Senior Care (JVSC) PACE

About Jordan Valley Health:

Jordan Valley Health (JVH) is a mission-driven organization dedicated to improving the health of individuals and families in underserved communities. We provide comprehensive healthcare services including primary medical dental vision and behavioral health. Our mission is simple: Improve our communitys health through access and relationships. By working collaboratively with partners and continually innovating JVH strives to be a leader in providing essential healthcare for the underserved ensuring everyone in our community has access to quality healthcare.

Job Summary:

The Member Services Coordinator is responsible for scheduling and tracking participants external (out-of-center) medical appointments and ensuring continuity of information between outside providers and the Jordan Valley Senior Care (JVSC) PACE Interdisciplinary Team (IDT). This includes coordinating specialist diagnostic hospital and other off-site appointments; following up to confirm appointments occurred and recommendations were received; retrieving and uploading external medical records into the participants chart; and supporting timely processing of that information to meet PACE regulatory timeframes. The Member Services Coordinator partners closely with the Business Office Coordinator on prior authorization status for external services and assists with scheduling participant escorts and transportation to support appointment attendance. This role is a key link between the PACE center and the broader community provider network that participants rely on.

Key Responsibilities:

• Schedules participant appointments with outside specialists diagnostic providers hospitals and other contracted or non-contracted external providers as directed by the IDT or primary care provider.
• Confirms appointment details (date time location transportation needs preparation instructions) with participants caregivers and outside provider offices and communicates these details clearly to participants and when applicable escorts.
• Tracks all scheduled external appointments on an ongoing basis and follows up proactively to confirm whether appointments were kept rescheduled or no-showed escalating missed or repeatedly rescheduled appointments to the IDT.
• Follows up with external provider offices after appointments to obtain visit summaries recommendations and any further orders or referrals and communicates outcomes to the IDT in a timely manner.
• Monitors outstanding/pending external appointments to help ensure IDT-approved services are scheduled and completed within PACE regulatory timeframes (generally no later than 7 calendar days from IDT approval or 48 hours following hospital emergency department or urgent care discharge consistent with 42 CFR Part 460).
• Maintains an organized tracking system of pending completed and follow-up-needed external appointments and produces status updates for the IDT Member Services Manager or compliance staff upon request.
• Receives incoming medical records consult notes diagnostic results and other clinical documentation from external providers via fax portal mail or direct pickup.
• Reviews incoming records for completeness and routes any clinically urgent findings to the appropriate IDT member immediately upon receipt ahead of routine filing.
• Uploads and files external records into the participants medical record/chart accurately promptly and in accordance with the organizations documentation and electronic health record (EHR) procedures.
• Tracks outstanding records requests (e.g. records not yet received from a specialist or hospital) and follows up with outside provider offices to obtain missing documentation needed for the plan of care.
• Ensures records are processed within timeframes that support the IDTs ability to review and act on outside recommendations consistent with PACE regulatory requirements and organizational policy.
• May assist in staging primary care provider notes based on outside specialist recommendations.
• Maintains confidentiality of all participant health information during receipt handling and filing of records consistent with HIPAA and organizational privacy policy.
• Works collaboratively with the Business Office Coordinator to confirm that prior authorizations for external/specialist services are requested obtained and on file before or in conjunction with scheduling as applicable.
• Communicates scheduling needs and timeframes to the Business Office Coordinator so authorization requests can be submitted without delaying participant access to care.
• Flags any scheduling conflicts authorization delays or denials to the Business Office Coordinator and IDT promptly so alternate arrangements can be made.
• Maintains accurate records of authorization status associated with scheduled external appointments to support billing accuracy and audit readiness.
• Assists with scheduling participant escorts to accompany participants to external appointments coordinating timing with transportation and the receiving providers office.
• Communicates appointment logistics (pick-up time destination appointment purpose anticipated duration) to escorts and transportation staff or vendors to support a smooth visit.
• Coordinates with transportation/escort staff on schedule changes cancellations or delays and reschedules promptly when needed to minimize disruption to the participant and the IDTs care timeline.
• Documents escort assignments and transportation arrangements consistent with organizational recordkeeping practices.
• Communicates regularly with the IDT regarding the status of external appointments pending records and any participant concerns identified during scheduling or follow-up calls.
• Attends IDT meetings or huddles as requested to report on external appointment and records status for assigned participants.
• Brings any participant-reported access transportation or scheduling barriers to the attention of the IDT and Member Services Manager so they can be addressed.
• All other duties as assigned.

Benefits Overview:

• Medical and Prescription Drug Coverage: Three comprehensive plan options (Buy-up Base and High Deductible) through UnitedHealthcares Choice Plus network covering various deductibles and out-of-pocket limits. Includes access to telemedicine services via Teladoc.
• Health Savings Account (HSA): Available for employees in the High Deductible Plan with employer contributions and tax advantages.
• Flexible Spending Account (FSA): Options for both healthcare and dependent care FSAs allowing pre-tax contributions for qualified expenses.
• Dental and Vision Coverage: Dental insurance through Cignas DPPO network and vision coverage through EyeMeds Insight network.
• Retirement Plan: Pre-tax and Roth 403(b) retirement plans with a 5% employer match starting after 30 days of employment.
• Life and Disability Insurance: Basic Life and AD&D insurance provided at no cost with the option to purchase additional coverage. Long-term and short-term disability insurance are also available.
• Employee Assistance Program (EAP): Free confidential support for personal and professional challenges including counseling and crisis intervention.
• Additional Voluntary Benefits: Options for critical illness accident hospital care and pet insurance through MetLife.

Holidays:

• Nine paid holidays per year.

Health Requirements:

All employees are required to provide proof of vaccination for Flu Hepatitis B and Tuberculosis (TB) as part of our commitment to maintaining a safe and healthy workplace.

Application Process:

Interested applicants should submit a resume and cover letter through the JVH career portal at Careers & Education - Jordan Valley. Applications will be accepted on a rolling basis until the position is filled.

Jordan Valley Health is an equal opportunity employer. All applicants will be considered for employment without attention to race color religion sex sexual orientation gender identity national origin veteran or disability status.

Required Qualifications:

• Minimum of one to two years of experience in medical scheduling referral coordination health information/medical records or a medical office/clinic setting required.
• One year of experience working with frail or elderly population or if the individual has less than one year of experience must receive appropriate training from the PACE organization on working with a frail or elderly population upon hiring.

Preferred Qualifications:

• High school diploma or equivalent preferred.
• Associates degree or coursework in health care administration medical office administration or a related field preferred.
• Experience working with older adults in a geriatric or long-term care setting or within a managed care PACE or interdisciplinary care model is preferred.