Job Description

Description

The Care Coordination Manager is responsible for care coordination for members seeing Utah Market providers who are paneled with our payer partners. This manager coordinates the comprehensive approach to immediate and/or ongoing care of their complicated and/or catastrophic medical illness and assures the clinic network’s providers meet the expectations of the plans/patients. This individual documents interactions with and on behalf of the member throughout clinic care delivery (multiple encounters) that includes, but is not limited to: care plans, progress notes, correspondences, and authorizations. In attrition, this individual uses business intelligence and knowledge of payer quality requirements to independently triage patient needs based on the return on investment and clinical cost/benefit. This individual is a member of the clinical leadership team and reports to senior leadership within the Utah employed provider network and the Steward Clinical Operations team.

 

Key Responsibilities

Identify patients who have had a recent transition of care and assist with follow up and discharge and/or further access to care needs

Serve as the point person for various insurance companies to coordinate patients seeking care in our offices

Interfaces with payer decision makers on new services offered at locations within the employed provider network

Develops strategic plans for and documents collection of the various quality measures (HEDIS, CQMs, Core Measures, etc) that are missing for patient’s medical condition or age at the direction of the AVP-QI, Risk and Clinical Compliance

Develops and assesses reports using information from the health plans regarding those patients that are high utilizers of ERs or Urgent Care Centers and independently identifies ways to decrease inappropriate utilization

Manages, using direction from the AVP- QI, Risk and Clinical Compliance, under and overutilization by the Utah network of employed providers

Educates all stakeholders on better options for appropriate utilization including patient (ie: calling our offices first, for non-life threating conditions versus using the ED)

Provide supportive services to patients when scheduling appointments, transportation, finding community resources and work collaboratively with clinic leadership and/or case/debases managers from the payer partners to support the patient’s care plan

Consult Case and/or Disease Manager with the payer if the patient is in need of ongoing care coordination, at the direction of the provider

Ensures that gaps in care, service and data collection are addressed

Notifies the AVP-QI, Risk and Clinical Compliance situations giving rise to clinical risk management issues (unsafe conditions, complications with care deliver, etc)

Review the monthly ER report to identify patients and providers who have had high levels of ED utilization and assist the primary care provider and/or clinic leadership to determine appropriateness for high ED utilization

Educate patients and providers on services available to address chronic disease, chronic illness management or other identified reasons for utilization of the ER

Assist with outreach projects and chronic care improvement programs

Attends required meetings

Completes assigned training and education 



Qualifications

Minimum Requirements

High School diploma or GED equivalent required

One to three years’ experience in a managed care

Previous clinic experience as a case manager or clinic leadership

Three to five years’ experience interfacing with patients on care needs or patient engagement experience required

Knowledge and experience with Microsoft Office products required

Strong interpersonal communication skills required

Strong organizational skills required

Ability to independently develop effective action plans based on current condition(s), data stream analysis or other sources of information

Basic computer knowledge

Institutional accreditation and degree obtainment will be verified upon hire

 

Preferred Qualifications

Previous Clinical experience

Bachelor’s degree in related field

Certified Case Manager, Certified Disease Manager, Certified Professional of Health Quality (or equivalent)

Additional languages preferred, not required

 

Physical Requirements

Standing, sitting, walking, speaking, listening, bending, reaching, pushing, pulling, lifting, grasping and manipulating tools, typing, using peripheral computer tools

 

Please Note
All positions subject to close without notice

Equal Opportunity Employer Minorities/Women/Veterans/Disabled 

Application Instructions

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