Lead Managed Care Coordinator, FT, Days

Located in Kailua, Adventist Health Castle has been one of the area's leading healthcare providers since 1963. We are comprised of a 160-bed hospital, eight medical offices, home care services, urgent cares and a vast scope of services located throughout O'ahu. In 2017, Adventist Health Castle was recognized with the Malcolm Baldrige National Quality Award, the nation's highest presidential honor for performance excellence. O'ahu is known for its ideal climate, diverse culture and picturesque landscape. The allure of Castle's laid-back lifestyle is complimented by its close-knit and proud community.

Job Summary:

Formulates, implements and executes successful project completions based on group’s initiatives. 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 the team or work group. Focuses on coaching and coordination of care for high-risk patients as well as motivating specific patient populations to complete wellness screenings as required by individual health plans. Works alongside the physicians and office staff to identify needs of complex patients while assisting the practice to develop a process for managing its patient population. Promotes patient-centered care, works side-by-side with physicians and medical home/neighborhood team members, and actively participates in multidisciplinary patient-centered team meetings.

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' relevant experience: Preferred
• Motivational experience: Preferred

Essential Functions:

• Serves in Project Coordinator role as follows: Patient outreach (targeted campaigns based on preventative health screenings, including scripting and monitoring for outreach calls and coordinating mass mailers); Audits (working with insurance companies on behalf of the group to ensure audits are submitted on time); Organizing and leading community events that align with our physicians and community wellness goals. May also coordinate office workflows and provide training and assistance to care coordinators for program startup and success and serve as point of contact for HMSA, MDX and other similar programs. AWVs: Collaborates with insurance companies on data collection and tracking. Utilizes the data and creates a plan with care coordinators to improve physicians’ quality performance.
• Serves as a Lead in the department and resource for other Managed Care Coordinators. Coordinates assignments as needed and manages workflow for care coordinators and/or physicians aligned with key projects. Establishes timeline, documents implementation plan, and executes timeline for project completion. Serves as subject matter expert and utilizes both internal and external resources as needed to achieve success.
• Works as a Managed Care Coordinator, assessing patient needs and developing 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, including, but not limited to, measles, mumps, flu (based on the se