Health Plan Care Management Coordinator

About the role

Coordinates and provides utilization, disease and case management, and health coaching to health plan members. Serves as working supervisor for team or work group.

Responsibilities

• Liaises with 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.
• 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.
• Safeguards 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.

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

Qualifications

• 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.

Skills

• Substantial knowledge and experience in utilization, disease and case management.
• Effective communication skills.
• Collaborative problem-solving abilities.
• Knowledge of healthcare policies and procedures.

Benefits

Adventist Health offers a comprehensive benefits program for qualifying positions, including medical, dental, vision, retirement, paid time off, and more. For more information, please contact our Talent Acquisition team.

Pay

The estimated base pay for this position is $25.00 to $27.58. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package.

Schedule

Full time, Day Shift