Managed Care Coordinator, Full-time, Day shift

Adventist Health•Kailua-Kona, HI

17h•$25 - $32

About The Position

The Managed Care Coordinator works with multidisciplinary healthcare teams in assigned physician office settings. The role focuses on coaching and coordinating care for designated patients and motivating high-risk patient populations to complete wellness screenings required by individual health plans. The coordinator works with physicians and office staff to identify patient needs and help practices develop processes for managing their patient populations. The position promotes patient-centered care, works alongside physicians and medical home/neighborhood team members, and participates in multidisciplinary patient-centered team meetings. The coordinator assesses patient needs and develops care plans with physicians; coordinates enrollment in case management services; liaises between physician offices and population health organizations; develops workflows, standing orders, and protocols; reviews patient population data; and monitors attribution for capitated contracts. The role also documents and tracks care and quality performance, educates patients and caregivers, supports patient outreach, collaborates with providers and office staff, participates in training and backup coverage, and helps providers understand programs, measurements, and workflows.

Requirements

High school education/GED or equivalent is preferred.
Associate's/technical degree or equivalent combination of education and related experience is preferred.
Three years of related experience is preferred.
Motivational experience is preferred.
Associates must receive required vaccinations as a condition of employment and annually thereafter where applicable; medical and religious exemptions may apply.

Nice To Haves

High school education/GED or equivalent.
Associate's/technical degree or equivalent combination of education and related experience.
Three years of related experience.
Motivational experience.

Responsibilities

Assess patient needs and develop care plans in collaboration with medical home/neighborhood physicians.
Work with insurance companies or other organizations to enroll patients in case management services.
Serve as a liaison between physician offices and organizations focused on population health initiatives, ensuring physicians receive care plans and patient progress updates.
Work with physician office staff and Patient-Centered Medical Home/Medical Neighborhood physicians to develop standing orders and protocols.
Review data for patient populations based on insurance company contracts.
Create patient-centered medical home protocols through workflows and patient outreach.
Monitor patient attribution for capitated contracts.
Complete documentation in accordance with established policies and procedures.
Track and report care provided through databases to support appropriate provider reimbursement for quality performance.
Provide education to patients and caregivers.
Distribute preventive screening education materials and make calls to support patient outreach.
Collaborate with providers, office staff, and other care coordinators in a team-based care environment.
Participate in training and cross-training, and provide backup coverage.
Learn programs and educate providers about programs, measurements, and implementation of new workflows.
Perform other job-related duties as assigned.