Managed Care Coordinator

4 weeks ago

Sonora, United States Adventist Health Full time
Job Description

Adventist Health Sonora has been one of the area's leading healthcare providers since 1900. We are comprised of a 72-bed hospital, 30 medical offices, comprehensive cancer care and a vast scope of award-winning services located throughout Tuolumne and Calaveras counties and the surrounding areas. Sonora is known for its friendly hometown charm, vast outdoor experiences and lively downtown. The allure of Sonora's close-knit community is complimented by its proximity to Yosemite National Park, as well as just a quick drive to Lake Tahoe.

Job Summary:

Works with multidisciplinary healthcare teams in assigned physician offices settings. Focuses on coaching and coordination of care for designated patients as well as motivating high-risk patient populations to complete wellness screenings as required by individual health plans. Works alongside the physicians and office staff to identify needs of patients while assisting the practice to develop a process for managing its patient population. Promotes patient-centered care, works side-by-side with physicians and medical home/neighborhood team members, and actively participates in multidisciplinary patient-centered team meetings.

Job Requirements:

Education and Work Experience:
  • High School Education/GED or equivalent: Preferred
  • Associate's/Technical Degree or equivalent combination of education/related experience: Preferred
  • Three years' related experience: Preferred
  • Motivational experience: Preferred
Essential Functions:
  • Assesses patient needs and develops care plans in collaboration with the medical home/neighborhood physicians. Works with insurance companies or other organizations to enroll patients in case management services. Serves as liaison between physician offices and other organizations focused on population health initiatives to ensures physicians receive plan of care and status updates on patient progress.
  • Works with physician office staff and Patient-Centered Medical Home/Medical Neighborhood physicians to develop standing orders and protocols. Reviews data for populations of patients based on insurance company contracts. Creates patient-centered medical home protocols through workflows and patient outreach. Monitors patient attribution which is vital to capitated based contracts.
  • Performs all documentation requirements in accordance with established polices and procedures. Tracks and reports via databases on care provided to ensure provider gets reimbursed appropriately for quality performance.
  • Provides patient and caregiver education. Distributes preventative screening education material and makes phone calls to assist with patient outreach.
  • Works collaboratively in a team-based care environment with providers, office staff and other care coordinators. Participates in training and/or cross-training of duties and provides backup coverage. Learns programs and provides education for providers to understand programs and measurements and how to implement new workflows.
  • Performs other job-related duties as assigned.


Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

About Us

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of 37,000 includes employees, physicians and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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