Care Coordinator - Focus on Medicare Advantage patient advocacy (PLEASANTON)

POSITION SUMMARY / RESPONSIBILITIES

CareCoordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.

EDUCATION / EXPERIENCE

Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.

LICENSURE / CERTIFICATION

Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.