Job detail

Health Plan Care Management Coordinator

Adventist Health

#Nonprofit #Case Management #Patient Flow #E-Verify #Performance Improvement #Liaison #Discharge Planning #Quality Improvement #Care Management

Quick overview

This role coordinates and provides utilization, disease and case management, and health coaching services to health plan members, applying advanced knowledge to meet goals and potentially serving as a working supervisor. Key functions include acting as a liaison to various parties, leading retrospective reviews, confirming orders, and enhancing communication related to care coordination and utilization management.

Requirements summary

While a High School Education/GED is preferred, an Associate's/Technical Degree or equivalent experience is also preferred, along with five years of related experience. Essential functions involve collaboration with physicians and leadership on quality initiatives and ensuring ongoing collaboration to meet medical necessity criteria.

high schoolassociate degreeCoordinationCollaborationQuality ImprovementLiaisonDischarge PlanningPerformance ImprovementDisease ManagementPatient FlowCare ManagementUtilization ManagementHealth CoachingCapacity ManagementMedical Necessity CriteriaRetrospective ReviewClinical Cost Reduction

Job description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary

Coordinates and provides utilization, disease and case management, and health coaching to health plan members. Applies substantial knowledge and experience to perform a wide range of advanced activities and/or determines how to use resources to meet schedules and goals; serves as working supervisor for team or work group.

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
Five years' related experience: Preferred

Essential Functions

Functions as liaison to members, providers, case coordinators, discharge planners, contracted health plans/partners and internal departments. Leads retrospective review process. Confirms orders utilizing established criteria.
Enhances communication related to discharge planning and utilization management. Maintains effective communication with health care team members related to care coordination and utilization management. Performs ongoing collaboration with staff to ensure condition meets medical necessity criteria.
Works collaboratively with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction initiatives.
Ensures ongoing collaboration with staff to ensure condition meets medical necessity criteria. Communicates changes that could affect the discharge plan of care.
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 as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.