Managed Care Coordinator

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 as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.