Category:

Professional

City:

Jackson

State:

Tennessee

Shift:

Day (United States of America)

Job Description Summary:

The Quality Care Coordinator will work in collaboration with the leadership of WTMG and its network of employed and aligned providers to create and implement care coordination solutions, to achieve the goals and objectives of the system’s value-based payment initiatives, including its PCMH programs and MSSP ACO programs.

ESSENTIAL JOB FUNCTIONS:

• Ensure we have established the operating systems and clinical care team interactions which:
• Accurately identify our health system/provider practice patients in need of care coordination and what appropriate level is required
• Ensure timely care coordination of patients in need of preventative care and chronic care gap services. Monitor and ensure appropriate closing of preventative services and gaps in care.
• Optimize use of health system assets like specialists, home health, rehabilitation, and DME services.
• Work with the system’s Quality Steering Committee to identify care coordination needs of the network and develop strategies to address.
• Collaborate with payres and medical group leadership to design strategic approach to lowering health care spending.
• Monitor all quality, cost, and efficiency for pertinent initiatives and partnerships on a regular basis.
• Develop clinical pathways and communication channels between payers, hospitals, clinical practices, home health, and skilled nursing facilities to address care coordination needs within the patient population.
• Develop a stratification process for identifying patients with need for intervention by Care Coordination and/or Chronic Care Management.
• Participate in building and maintaining relationships within WTMG providers/networks.
• Work with the WTMG clinics and quality leadership to develop and implement a strategic plan for improving care and patient outcomes through care coordination needs.
• Create standard ambulatory level of care decision making tools to be utilized care management teams with patients and families.
• Attend with leadership in developing regular meeting schedule with the clinical and care coordination leaders from all stakeholders (payers, hospitals, medical group, and post-acute providers) to ensure effective communication in aligning the mission of the system with ongoing initiatives, including the execution and tracking of goals.
• Collaborate with Committee, related consultants, and IT staff to generate necessary data to measure improvement and support the system’s goals and objectives.
• Performs related responsibilities as required or directed.

JOB SPECIFICATIONS:

EDUCATION:

• Minimum Licensed Practical Nurse

LICENSURE, REGISTRATION, CERTIFICATION:

• Clinical licensure in Nursing or Social Work preferred
• Current Licensure in the State of Tennessee

EXPERIENCE:

• Minimum of 3 years’ experience in healthcare, practice operations experience highly preferred
• Previous experience with provider education, collaboration, and successful change management

     KNOWLEDGE, SKILLS AND ABILITIES:

• Highly detail-oriented, motivated, self-directed with a propensity towards action and results
• Excellent communication, presentation, influencing and facilitative skills with the ability to work collaboratively across all levels of the organization.
• Ability to effectively communicate complex subject matter expertise to various audiences and provide thought leadership regarding identifying and solving for challenges within all areas of care coordination
• Excellent working knowledge of care coordination continuum including skilled nursing facilities, home health, rehabilitation, and palliative care
• Strong knowledge of value-based care and Medicare programs, including Medicare Shared Savings and Medicare Advantage
• General knowledge of state and federal health care laws
• General knowledge of health plan operations
• Ability to maintain a professional demeanor and confidentiality
• Proven ability to build and strengthen working relationships, and effectively interact with all levels of staff, management and key stakeholders

NONDISCRIMINATION NOTICE STATEMENT

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, or any other characteristic protected by law.