Managed Care Coordinator, Full-time, Day shift

Adventist Health•Kailua, HI

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, motivating high-risk patient populations to complete wellness screenings required by their health plans, and helping practices develop processes for managing their patient populations. The coordinator promotes patient-centered care, works alongside physicians and medical home/neighborhood team members, and participates in multidisciplinary patient-centered team meetings. Located in Kailua, Adventist Health Castle is a healthcare provider serving O'ahu through a 160-bed hospital, medical offices, home care services, urgent cares, and other services. The organization requires associates to receive required vaccinations as a condition of employment and annually thereafter where applicable; medical and religious exemptions may apply. Adventist Health participates in E-Verify.

Requirements

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

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 plans of care 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-based contracts.
Complete documentation in accordance with established policies and procedures.
Track and report care provided via databases to help ensure providers are reimbursed appropriately for quality performance.
Provide patient and caregiver education.
Distribute preventive screening education materials and make phone calls to support patient outreach.
Collaborate in a team-based care environment with providers, office staff, and other care coordinators.
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.