Patient Case Manager

Description :

We are looking for a full time Nurse Care Coordinator to join our Spanish Peaks Regional Health Center clinic team! The Nurse Care Coordinator will take a team-based approach through effective partnerships with patients, providers, specialists and other healthcare team members to ensure seamless patient care and optimize revenue through effective utilization of Medicare and other payor programs.  This is a Monday-Friday Full time position with great benefits!

Pay Range : $33.54-$50.29 per hour based on experience and qualifications

Requirements :

Essential Job Functions :

Attend and actively participate in all Care Coordination related training and meeting activities.

Perform other functions as required to fulfill the expectations of the Care Coordinator role.

Demonstrate proficiency in understanding and implementing Medicare programs, such as Chronic Care Management (CCM), Complex Chronic Care Management (CCCM) and Transitional Care Management (TCM), ensuring patient eligibility and appropriate service delivery.

Accurately document care coordination services, apply correct billing codes, submit claims, track claim status, and appeal denials.

Utilize panel management data to drive data-driven improvements in patient outcomes, focusing on team-based care and securing payment incentives from Medicare and advantage plans.

Collaborate with payers to identify quality measures and close care gaps.

Organize and conduct various visit types, including Annual Wellness Visits, Transitional Care Management visits, and Chronic Pain Management visits.

Proactively identify potential patient issues to reduce unnecessary emergency department and hospital admissions and tests and ensure timely follow-up after hospital discharges and emergency department visits.

Provide ongoing care and support for patients with chronic conditions (e.g., diabetes, heart disease, cancer) through patient education, proactive outreach, reminders, and support, addressing patient concerns to improve engagement, treatment adherence, and satisfaction.

Facilitate effective communication between providers, specialists, and other healthcare team members outside of scheduled visits, ensuring timely and accurate sharing information for designated patients.

Collaborate with providers to manage complex patient cases, including coordinating referrals, monitoring and adjusting treatment plans, and scheduling specialist appointments.

Coordinate the Medication Assisted Treatment (MAT) program, including scheduling and facilitating inductions, referrals, staff training, and follow-up calls in collaboration with the provider.

Manage administrative tasks, including medication refills and complex follow-up calls beyond the scope of medical assistants.

Review provider workloads, address urgent issues and abnormal results, submit urgent prescriptions, and assist with phone and in-person triage, complementing the roles of the triage LPN and medical assistants.

Assist in survey readiness activities, contributing to the avoidance of deficiencies in regulatory surveys.

Minimum Required Education / Experience : Associates degree in nursing is required. Minimum of two years work experience in clinic nursing care is required. Experience with coding and billing for Medicare care coordination services, Medicare care coordination programs, MAT programs and quality improvement initiatives is preferred.

Pre-Employment Knowledge, Abilities and Skills :

Ability to operate general office equipment including computer software applications.

Demonstrated ability to recognize and response to opportunities for improvement through continual learning, changes in approach based on situation and professional practice behavior.

Knowledge of clinical care-based practices.

Outstanding verbal and written communication skills.

Ability to establish and maintain effective relationships with the public, other agencies, employees and administration.

Excellent time management skills.

Strong organizational skills and attention to detail.

Ability to develop and implement patient care plans and deliver patient education effectively.

Strong and accurate documentation skills.

Comfort with independently reviewing provider workloads and triaging patient needs.

Experience with chronic care management and medication management.

Proficiency in using panel data and accessing data across multiple EMR / data platforms.

Note : An acceptable combination of education, training and experience that provides the above knowledge, abilities and skills may be substituted.

Licenses or Certificates : Valid state license as an RN. Current Basic Life Support / CPR certification.

Necessary Special Requirements : Must obtain annual flu vaccination and any job-specific immunizations. Required to submit to a tuberculosis screening process.

Unusual Demands : Work is subject to recurring and inflexible deadlines and frequent interruptions.

Benefits :

All Employees are eligible for :

• Employee Assistance Program
• 403B retirement fund options (employer match after one year of employment)

Full and part-time positions are eligible for :

If youre considering joining our team this position will be open for a minimum of 5 days or until filled.

Compensation details : 33.54-50.29 Hourly Wage

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