Job Description

Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where out patents live. Steward - the largest privately held health care company in the U.S. - owns and operations 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lies through the company's managed care and health insurance services. The total number of paneled lives within Steward's integrated care network is projected to reach 3 million in 2018.

Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.

Position Summary:

The Care Coordinator is responsible for care coordination for members who require a comprehensive approach to immediate and/or ongoing care of their complicated and/or catastrophic medical illness. The Care Coordinator documents interactions with and on behalf of the member throughout service delivery including, but not limited to: care plans, progress notes, correspondences, and authorizations.

Key Responsibilities:

  • Identify patients who have had a recent transition of care and assist with follow up and discharge and/or further access to care needs.
  • Serve as the point person for various insurance companies to coordinate patients being seen in our offices.
  • Document the various quality measures (HEDIS, CQMs, Core Measures, etc.) that are missing for that patient’s medical condition or age at the direction of the Manager, Clinical Compliant and AVP-QI, Risk and Clinical Compliance.
  • Identify members through the reports from the health plans regarding those patients that are high utilizers of ERs or Urgent Care Centers and identify ways to decrease inappropriate utilization. Communicate with the patient the better option of calling our offices first, for non-life threating conditions.
  • Provide supportive services to patients when scheduling appointments, transportation, finding community resources and work collaboratively with the clinical care coordinator and/or case managers to support the patient’s care plan.
  • Consult Case and/or Disease Manager with the payer if the patient is in need of ongoing care coordination, at the direction of the primary care provider.
  • Help ensure that gaps in care, service and data collection are addressed.
  • Notifies the Manager, Clinical Compliance and/or AVP-QI, Risk and Clinical Compliance situations giving rise to clinical risk management issues (unsafe discharges, complications with care deliver, etc.)
  • Review the monthly ER report to identify those patients who have had high levels of ED utilization. Assist the primary care provider and/or Manager, Clinical Compliance to determine appropriateness those ED visits.
  • Educate patients and providers on services available to address chronic disease, chronic illness management or other identified reasons for utilization of the ER. If the face of the organization to providers in the community who might partner to care for patients.
  • Assist with outreach projects and chronic care improvement programs.
  • Attends required meetings.

Minimum Requirements:

  • High School Diploma or GED
  • Minimum of one (1) year in a managed care.
    • May accept clinic experience as a case manager.
  • Knowledge and experience with Microsoft Office products
  • Strong interpersonal, communication, and organizational skills
  • Strong organizational skills

Preferred Qualifications:

  • Clinical background
  • Three (3) to five (5) years’ experience interfacing with patients on care needs
  • Undergraduate degree

Application Instructions

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