The Population Coordinator supports medical management for specific lines of business such as Medicare Advantage, AHCCCS and other contracted members with increased emphasis on those members that are at risk for increased utilization of services. Support is evidenced by assisting members with care transitions between settings, examining utilization criteria and using clinical expertise to help support the transition process. In addition, the Population Health Program Supervisor assists with development, implementation and monitoring of quality and outcome measures. This position also reviews data to assess for trends in populations and conditions and in order to positively impact departmental productivity and performance outcomes.
- Acts as a liaison and patient advocate between patient, patient families, practice clinicians, specialists, facilities/agencies by providing supporting medical information and facilitating communication though the continuum of care.
- Through data analysis, case studies and trending reports, identifies and recommends projects that may decrease utilization.
- Works effectively with Complex Case Manager to coordinate case transition when needed.
- Leads an interdisciplinary team to manage the population health needs of the Medicare Advantage and other payers’ patients.
- Monitors and analyzes inpatient and outpatient data to identify admission and readmission trends, root causes for admissions.
- Identifies and builds effective relationships with a network of community, government and knowledge resources.
- Identifies cases appropriate for long-term case management and follows process for referral.
- Ensures that care teams are using appropriate readmit risk assessment tools, such as HRA’s, LACE (or similar tool), Four Domains (or similar tool). Uses risk scoring to lead appropriate prioritization of services to ensure patient safety and reduce readmission risk.
- Good command of data management and development of data-driven processes that improve care, and/or decrease cost
- Strong oral, written, and presentation skills required in order to represent the organization to internal and external customers
- Can show proof of success in the following areas:
- Basic knowledge of analytic tools and data management skills.
- Ability to drive results with real examples of successes
- Population Health Management experience that has resulted in appropriate utilization of services and knowledge of community services preferred
- Arizona licensed Registered Nurse with a minimum of 2 years of experience in utilization management, Case Management, Care Coordination or related area
- Thorough knowledge of current standards of patient care and utilization tools such as Milliman and Interqual
Qualification & Experience:
- 3-5 years work experience in inpatient, ED or critical care services preferred
- Preferred minimum 2 years of formal or informal management of people and or processes
- Computer and Microsoft application proficiency
Vacancy Type: Full Time
Job Functions: Health Care Provider
Job Location: America, OK, US
Application Deadline: N/A