Coordinated Care Manager

Job Summary:

Under the direction of the Director of Managed Care and Special Projects, the Coordinated Care Manager, works with internal and external teams to achieve operational excellence in patient centered care. The Coordinated Care Manager is responsible for revenue enhancement around such initiatives, seeking additional billing and coding opportunities, as well as payer savings. The Coordinated Care Manager demonstrates knowledge and skills to appropriately communicate and interact with staff, patients, families and visitors of all age groups while being sensitive to their cultural and religious beliefs.

Job Responsibilities:

Liaising with the COO, director, and executive staff to make decisions for operational activities and set strategic goals

Engaging staff from different departments and provide constructive feedback

Develop a comprehensive performance improvement process inclusive of all insurance and non-insurance payer types

Thoroughly and accurately ensure compliance with ACO and insurances requirements/specifications for annual wellness visits

Identify members with chronic conditions and / or gaps in care that can be positively impacted, as it relates to quality and care costs

Plan and monitor the day-to-day processes to ensure smooth progress toward unique initiative goals and the mission of the organization

Collaborate with staff from different departments and provide constructive feedback and creative ideas for operational excellence

Evaluate overall performance by gathering, analyzing, and interpreting data and assess regularly the efficiency of organization systemic processes

Collaborate with the appropriate individuals to offer ideas and solutions to refine and improve existing practices that will enhance patient outcomes

Manage revenue enhancement processes and coordinate material and resources allocation

Distribute educational information to patients and educate patients on preventive measures

Ensure that proactive measures for wellness visits are achieved

Develop processes for a care coordination/care management program to ensure continuity of care

Ensure follow up so that patients attend needed appointments to address gaps in care

Enhance revenue opportunities by CCM billing for patients with chronic conditions

Focus on regular, seamless care with gap measures met for all patients, providing direct, regular follow up with hypertensive and diabetic patients via CCM best practices

Ensure that all needed measures are ordered and appropriately addressed by providers at each visit

Identify gap opportunities for all visits not just wellness visits

Revise and/or formulate processes and promote their implementation and adoption

Provide coaching and education to internal staff about risk coding, CPTs codes, use of technology and payer resources to improve and manage quality

Provide coaching and learning opportunities to all staff, ensuring evidence based practices and translation/adoption to activities/processes

Oversee customer support processes and organize the steps to provide the very best customer satisfaction

Performs other special projects as assigned by the COO

Completes the required IT/Security trainings prior to the deadline

Effectively evaluates employees by completing 6 month and annual evaluations prior to the deadline

Counsels employees on areas of improvement by completing trainings and PCN's in a timely manner

Job Requirements:

At least 10 years of experience in health care, promoting prevention and primary care

2 years of supervisory experience preferred

Excellent organizational and leadership abilities

Outstanding communication and people skills

Ability to work independently

In depth knowledge of diverse business functions and principles (e.g. supply chain, finance, customer service etc.)

Working knowledge and application of data analysis and performance/operation metrics

Familiarity with MS Office and various business software (e.g. electronic medical records, patient / payer portals, data sources available)

Master's degree in health administration, public health, or health related field preferred

Physical and Other Requirements:

Continuously listen, visualize, and have dexterity and eye-hand coordination

Frequently sit, squat, reach, use both right and left forearm rotation, walk and stand

Occasionally kneel, twist, have ability to grasp firmly, lift and carry, push and pull in excess of 10 lbs.