The Care Coordinator Manager is a clinically trained RN patient advocate striving to coordinate the delivery of comprehensive, quality care and services at the right time. The Manager is responsible for the overall management and operation of the Care Coordinators. The care coordination program strives to achieve the best quality outcomes, highest patient satisfaction, highest provider/staff satisfaction while providing the most cost-effective care.
Responsibilities include, but are not limited to:
- Assists in the efficient and effective supervision of the Care Coordinators and Care Coordination program.
- Assist in closing quality gaps and providing patient education.
- Follows standing orders and protocols to meet quality initiatives.
- Engages with patients by utilizing motivational interviewing to complete necessary screening tests.
- Collaborate with Physicians and Advanced Practicing Providers to appropriately risk adjust patients via HCC coding and order needed tests.
- Assists in developing process and procedures that ensures thorough review of multiple patient level actionable reports, such as care reports, ER/Discharge patient lists, and risk adjustment lists.
- Evaluates the effectiveness, necessity, and efficiency of the treatment plan and communicates with the PCP and health care delivery team to recommend changes.
- Completes Transitional Care call to all identified patients to facilitate and oversee discharge planning needs.
- Facilitates PCP and/or Specialist post discharge hospital follow up appointments and documents available facility treatment history.
- Communicate clearly with all team partners.
- Identifies cases appropriate for chronic care and case management programs and follows process for referral.
- Works effectively with available Care Coordinators to coordinate case transition when needed.
- Identify and build effective relationships with a network of community resources.
- Establish and maintain a professional, collaborative positive relationship with the patient, family, physician(s), and other providers to assess the options for care and use of benefits and community resources.
- Maintains appropriate documentation and tracking as required by BWC and insurance companies.
- Coordinates and identifies high risk population with a history of polypharmacy, to improve quality outcomes with appropriate support services in managing pharmacy needs.
- Act as liaison between BWC and other entities regarding prior authorization requests.
- Educate team partners in regard to BWC's health management programs.
- Represents BWC as a member of a cross-functional project team.
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To be successful in this role, the candidate must: - Be a graduate of an accredited Registered Nurse program.
- Have a current license to practice as a Registered Nurse in North Carolina.
- Possess excellent oral and written communication skills.
- Understand ACOs, Value Based Care, and Managed Care programs.
- Be comfortable working in a team environment, while exhibiting flexibility and enthusiasm in learning new information and developing new skills quickly.
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