This position provides comprehensive care coordination for members/patients as assigned. This position assesses the members/patients plan of care needs, and develops, implements, monitors and documents the utilization of resources and progress of the member/patient through their care episodes, facilitating options and services to meet the members/patients health care needs. The intensity of care coordination provided is situational and appropriate based on member/patient need and payer requirements. This position is accountable for the quality of case management services delivered by both them and others and identifies/resolves barriers which may hinder effective member/patient care.
Manages individual members/patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Acts in a leadership function with process improvement activities for populations of patients/members to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Evaluates the medical necessity and appropriateness of care, optimizing member/patient outcomes.
Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
Acts in a leadership function to collaboratively develop and manage the High Need/High Cost Program and manage the interdisciplinary member/patient case staffing to ensure high levels of care coordination to promote improved health care outcomes or discharge plan. Effectively communicates the plan across the continuum of care.
Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice.
Requires bachelors degree in social work or related field or equivalent experience.
Requires a proficiency level typically achieved with 5 years of clinical/case management experience and knowledge of Medicare and Medicaid Programs. Must have a working knowledge of care management, hospital and community resources. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively in an interdisciplinary team format.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.