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Adventist Health Portland · 4 weeks ago

Health Plan Care Management Coordinator (OR)

Portland, OR

Full-time

Onsite

Senior Level

5+ years exp

Adventist Health Portland is a faith-based, nonprofit health system serving communities on the West Coast and Hawaii. The Health Plan Care Management Coordinator is responsible for coordinating utilization, disease, and case management, as well as health coaching for health plan members.

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No H1B

Responsibilities

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