Health Plan Care Management Coordinator (OR) at Adventist Health

Roseville, California, United States -

Full Time

Start Date

Immediate

Expiry Date

05 Jun, 26

Salary

30.91

Posted On

07 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Care Management, Utilization Management, Disease Management, Health Coaching, Liaison, Retrospective Review, Discharge Planning, Medical Necessity Criteria, Quality Improvement, Performance Improvement, Patient Flow, Capacity Management, Clinical Cost Reduction, Collaboration, Coordination

Industry

Hospitals and Health Care

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. 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. Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

Responsibilities

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.